TY - JOUR
T1 - Regionally acquired intestinal failure data suggest an underestimate in national service requirements
AU - Barclay, Andrew
AU - Paxton, Catherine E
AU - Gillett, Peter
AU - Hoole, David
AU - Livingstone, Jennifer
AU - Young, David
AU - Menon, Gopi
AU - Munro, Fraser
AU - Wilson, David C
AU - GI/Nutrition Research Fund, Child Life and Health, University of Edinburgh (Funder)
PY - 2009/8
Y1 - 2009/8
N2 - With complete case referral for prolonged parenteral nutrition (PN) beyond term equivalent, serving a stable population of 1.25 million people, we describe the long term outcome and survival of patients referred to an intestinal failure (IF) nutrition support team over the first eight years of existence at a regional paediatric centre, and extrapolate to potential numbers of national home parenteral nutrition (HPN) cases and intestinal transplantation data. Retrospective analysis detailing patient demographics, interventions, use of home parenteral nutrition (HPN), occurrence of intestinal failure associated liver disease (IFALD), and outcomes of enteral
adaptation, survival, and referral for and receipt of organ transplantation. 23 patients were referred over eight years, 20 being PN dependent within the neonatal period. Diagnoses included short bowel syndrome (SBS) (18),neuromuscular abnormalities (4) and congenital enterocyte disorder (1). 12,696 days of PN were delivered with 314 confirmed episodes of sepsis at a median of twelve episodes per patient. 144 central venous catheters (CVC) were required at a median of four per patient. IFALD occurred in seventeen (73%) patients, with ten (44%) referred for transplant assessment. Thirteen (56%) children received HPN. Overall mortality was 44%. A significant predictor for survival in the SBS group was residual bowel
>40cm (82% vs. 28%, p=0.049). Survival for IF at 56% was lower than reported from non UK supraregional centres, and nationally collected data, possibly reflecting pre-selected referral populations. Data from regional centres with complete ascertainment may be important both when counselling parents and when planning regional and national
HPN and IF specialist services.
AB - With complete case referral for prolonged parenteral nutrition (PN) beyond term equivalent, serving a stable population of 1.25 million people, we describe the long term outcome and survival of patients referred to an intestinal failure (IF) nutrition support team over the first eight years of existence at a regional paediatric centre, and extrapolate to potential numbers of national home parenteral nutrition (HPN) cases and intestinal transplantation data. Retrospective analysis detailing patient demographics, interventions, use of home parenteral nutrition (HPN), occurrence of intestinal failure associated liver disease (IFALD), and outcomes of enteral
adaptation, survival, and referral for and receipt of organ transplantation. 23 patients were referred over eight years, 20 being PN dependent within the neonatal period. Diagnoses included short bowel syndrome (SBS) (18),neuromuscular abnormalities (4) and congenital enterocyte disorder (1). 12,696 days of PN were delivered with 314 confirmed episodes of sepsis at a median of twelve episodes per patient. 144 central venous catheters (CVC) were required at a median of four per patient. IFALD occurred in seventeen (73%) patients, with ten (44%) referred for transplant assessment. Thirteen (56%) children received HPN. Overall mortality was 44%. A significant predictor for survival in the SBS group was residual bowel
>40cm (82% vs. 28%, p=0.049). Survival for IF at 56% was lower than reported from non UK supraregional centres, and nationally collected data, possibly reflecting pre-selected referral populations. Data from regional centres with complete ascertainment may be important both when counselling parents and when planning regional and national
HPN and IF specialist services.
KW - parenteral nutrition
KW - home
KW - child
KW - short bowel syndrome
KW - intestinal transplant
U2 - 10.1136/adc.2008.141978
DO - 10.1136/adc.2008.141978
M3 - Article
VL - 94
SP - 938
EP - 943
JO - Archives of Disease in Childhood
JF - Archives of Disease in Childhood
SN - 0003-9888
IS - 12
ER -