Predictors of enteral autonomy in children with intestinal failure

A multicenter cohort study

Faraz A. Khan, Robert H. Squires, Heather J. Litman, Jane Balint, Beth A. Carter, Jeremy G. Fisher, Simon P. Horslen, Tom Jaksic, Samuel Kocoshis, J. Andres Martinez, David F Mercer, Susan Rhee, Jeffrey A. Rudolph, Jason Soden, Debra Sudan, Riccardo A. Superina, Daniel H. Teitelbaum, Robert Venick, Paul W. Wales, Christopher Duggan

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)29-34.e1
JournalJournal of Pediatrics
Volume167
Issue number1
DOIs
StatePublished - Jul 1 2015

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Multicenter Studies
Small Intestine
Cohort Studies
Parenteral Nutrition
Ileocecal Valve
Transplantation
Institutional Practice
Necrotizing Enterocolitis
Gastrointestinal Diseases
Referral and Consultation
Pediatrics
Incidence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Khan, F. A., Squires, R. H., Litman, H. J., Balint, J., Carter, B. A., Fisher, J. G., ... Duggan, C. (2015). Predictors of enteral autonomy in children with intestinal failure: A multicenter cohort study. Journal of Pediatrics, 167(1), 29-34.e1. https://doi.org/10.1016/j.jpeds.2015.03.040

Predictors of enteral autonomy in children with intestinal failure : A multicenter cohort study. / Khan, Faraz A.; Squires, Robert H.; Litman, Heather J.; Balint, Jane; Carter, Beth A.; Fisher, Jeremy G.; Horslen, Simon P.; Jaksic, Tom; Kocoshis, Samuel; Martinez, J. Andres; Mercer, David F; Rhee, Susan; Rudolph, Jeffrey A.; Soden, Jason; Sudan, Debra; Superina, Riccardo A.; Teitelbaum, Daniel H.; Venick, Robert; Wales, Paul W.; Duggan, Christopher.

In: Journal of Pediatrics, Vol. 167, No. 1, 01.07.2015, p. 29-34.e1.

Research output: Contribution to journalArticle

Khan, FA, Squires, RH, Litman, HJ, Balint, J, Carter, BA, Fisher, JG, Horslen, SP, Jaksic, T, Kocoshis, S, Martinez, JA, Mercer, DF, Rhee, S, Rudolph, JA, Soden, J, Sudan, D, Superina, RA, Teitelbaum, DH, Venick, R, Wales, PW & Duggan, C 2015, 'Predictors of enteral autonomy in children with intestinal failure: A multicenter cohort study', Journal of Pediatrics, vol. 167, no. 1, pp. 29-34.e1. https://doi.org/10.1016/j.jpeds.2015.03.040
Khan, Faraz A. ; Squires, Robert H. ; Litman, Heather J. ; Balint, Jane ; Carter, Beth A. ; Fisher, Jeremy G. ; Horslen, Simon P. ; Jaksic, Tom ; Kocoshis, Samuel ; Martinez, J. Andres ; Mercer, David F ; Rhee, Susan ; Rudolph, Jeffrey A. ; Soden, Jason ; Sudan, Debra ; Superina, Riccardo A. ; Teitelbaum, Daniel H. ; Venick, Robert ; Wales, Paul W. ; Duggan, Christopher. / Predictors of enteral autonomy in children with intestinal failure : A multicenter cohort study. In: Journal of Pediatrics. 2015 ; Vol. 167, No. 1. pp. 29-34.e1.
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abstract = "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.",
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AU - Khan, Faraz A.

AU - Squires, Robert H.

AU - Litman, Heather J.

AU - Balint, Jane

AU - Carter, Beth A.

AU - Fisher, Jeremy G.

AU - Horslen, Simon P.

AU - Jaksic, Tom

AU - Kocoshis, Samuel

AU - Martinez, J. Andres

AU - Mercer, David F

AU - Rhee, Susan

AU - Rudolph, Jeffrey A.

AU - Soden, Jason

AU - Sudan, Debra

AU - Superina, Riccardo A.

AU - Teitelbaum, Daniel H.

AU - Venick, Robert

AU - Wales, Paul W.

AU - Duggan, Christopher

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N2 - 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.

AB - 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.

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