A multicenter study on enteral autonomy outcome of pediatric intestinal failure patients from a middle-income country

Abstract

Background & aims: To identify predictors of enteral autonomy and survival in pediatric intestinal failure patients followed up at three pediatric intestinal rehabilitation centers from a middle-income country.

Methods: This retrospective multicenter cohort study evaluated patients with intestinal failure from three high-volume intestinal rehabilitation centers on long-term parenteral nutrition between 2014 and 2023. The primary outcome was status at the end of the follow-up: parenteral nutrition dependence, enteral autonomy, transplantation, or death. Secondary outcomes were complications resulting from treatment and current parenteral nutrition dependency index. Competing risk analysis, Cox regression, and a decision tree model were employed.

Results: The cohort comprised 207 patients with a median (interquartile range) age at admission of 6.2 (3.1; 12.9) months and a median follow-up of 29.4 (10.2; 49.6) months. Short bowel (85 %) and motility disorders (10.6 %) were the primary causes of intestinal failure. Cumulative incidence of 5-year for enteral autonomy and survival rates were 37 % and 88 %, respectively. Intestinal failure-associated liver disease was present in 24 % of patients on admission. Enteral autonomy was associated with remnant intestine length >40 cm (hazard ratio: 2.0; 95 % confidence interval: 1.7; 3.6); age at admission <6.2 months (hazard ratio: 1.8; 95 % confidence interval: 1.0; 3.3); and preserved ileocecal valve (hazard ratio: 3.4; 95 % confidence interval: 1.9; 6.0). The overall mortality rate was 7.7 %.

Conclusion: The overall survival rate was 92.3 % and the 5-year cumulative incidence of enteral autonomy was 37 %. The probability of achieving enteral autonomy was associated with early arrival at the intestinal rehabilitation center and favorable bowel anatomy.

Keywords: Children; Intestinal failure; Multicenter study; Short bowel syndrome.