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Regionally acquired intestinal failure data suggest an underestimate in national service requirements

Barclay, Andrew and Paxton, Catherine E and Gillett, Peter and Hoole, David and Livingstone, Jennifer and Young, David and Menon, Gopi and Munro, Fraser and Wilson, David C (2009) Regionally acquired intestinal failure data suggest an underestimate in national service requirements. Archives of Disease in Childhood, 94 (12). pp. 938-943. ISSN 0003-9888

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Abstract

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.