Original Article
Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study

https://doi.org/10.1016/j.jpeds.2015.03.040Get rights and content

Objectives

In a large cohort of children with intestinal failure (IF), we sought to determine the cumulative incidence of achieving enteral autonomy and identify patient and institutional characteristics associated with enteral autonomy.

Study design

A multicenter, retrospective cohort analysis from the Pediatric Intestinal Failure Consortium was performed. IF was defined as severe congenital or acquired gastrointestinal diseases during infancy with dependence on parenteral nutrition (PN) >60 days. Enteral autonomy was defined as PN discontinuation >3 months.

Results

A total of 272 infants were followed for a median (IQR) of 33.5 (16.2-51.5) months. Enteral autonomy was achieved in 118 (43%); 36 (13%) remained PN dependent and 118 (43%) patients died or underwent transplantation. Multivariable analysis identified necrotizing enterocolitis (NEC; OR 2.42, 95% CI 1.33-4.47), care at an IF site without an associated intestinal transplantation program (OR 2.73, 95% CI 1.56-4.78), and an intact ileocecal valve (OR 2.80, 95% CI 1.63-4.83) as independent risk factors for enteral autonomy. A second model (n = 144) that included only patients with intraoperatively measured residual small bowel length found NEC (OR 3.44, 95% CI 1.36-8.71), care at a nonintestinal transplantation center (OR 6.56, 95% CI 2.53-16.98), and residual small bowel length (OR 1.04 cm, 95% CI 1.02-1.06 cm) to be independently associated with enteral autonomy.

Conclusions

A substantial proportion of infants with IF can achieve enteral autonomy. Underlying NEC, preserved ileocecal valve, and longer bowel length are associated with achieving enteral autonomy. It is likely that variations in institutional practices and referral patterns also affect outcomes in children with IF.

Section snippets

Methods

We performed a multicenter retrospective cohort study among the PIFCon. The group was initiated in June 2006 as a collaboration among 14 sites with established multidisciplinary programs for treatment of pediatric IF; 9 of the 14 sites also had affiliated intestinal transplantation (ITx) programs. After Institutional Review Board approval was obtained from each participating center, records of patients who met inclusion criteria were reviewed retrospectively. Infants with IF were included if

Results

Select patient demographic and baseline characteristics are summarized in Table I. The 272 infants who met study inclusion criteria were followed for a median of nearly 3 years. Complete enteral autonomy was achieved in 118 (43%) by the end of the study follow-up period; 36 patients (13%) remained partially or exclusively PN dependent, and 118 (43%) patients died (n = 58), underwent intestinal/multivisceral transplantation (n = 50), or underwent transplant and then died (n = 10). The cumulative

Discussion

In this multicenter retrospective cohort of a large number of infants with IF, we found that almost one-half of all patients achieved enteral autonomy within the nearly 3 years of follow-up. Medical care at a nontransplantation IF program, underlying NEC, and a preserved ICV were all independently associated with enteral autonomy. A second multivariable model confirmed that longer measured RSB length also was an independent predictor of successful weaning from PN.

Our finding of a rate of

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Supported by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (1 R21 DK081059-01). C.D. was funded in part from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD058795 and K24DK104676-06). The authors declare no conflicts of interest.

A list of members of the Pediatric Intestinal Failure Consortium is available at www.jpeds.com (Appendix).

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