title: Systematic review: medical and nutritional interventions for the management of intestinal failure and its resultant complications in children.
abstract: BACKGROUND
  Intestinal failure (IF) affects a growing number of children due to increasing numbers of preterm infants surviving intestinal resection for necrotising enterocolitis and improving surgical techniques for congenital gut anomalies. Parenteral nutrition (PN) is the mainstay of therapy; enteral nutrition may have trophic effects on the gut.
  
  
  OBJECTIVE
  To review systematically evidence for the effectiveness of medical and nutritional interventions in the treatment of IF in children.
  
  
  METHODS
  Retrieval of data from studies of patients aged <18 years and receiving >28 days of PN. Outcome measures were improvement in intestinal function, intestinal adaptation, growth, prevention and treatment of IF-associated liver disease, and mortality. Cochrane Database (November 2009), MEDLINE (1950-November 2009) and CINAHL (1982-November 2009) electronic database searches were made using keyword and subject headings (MeSH): IF, Short Bowel Syndrome (SBS), PN and Child. The level of the evidence (EL) was assessed using SIGN (Scottish Intercollegiate Guidelines Network) methodology (http://www.sign.ac.uk).
  
  
  RESULTS
  From 1 607 620 hits, 720 abstracts were reviewed. Thirty-three original articles were included. No studies were of high methodological quality.
  
  
  CONCLUSIONS
  The evidence base for medical and nutritional interventions in paediatric IF is limited and of poor quality. In the absence of randomised-controlled trials, this evidence base can improve through case control and cohort research; and with better multiagency communication, the study of inter-centre differences is possible. Achievable short-term goals would include the study of: optimal ursodeoxycholic usage, novel intralipid formulations, cycled enteral antibiotics, enteral probiotics and new enteral feeding strategies.
authors.affiliation: Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK. a.barclay@clinmed.gla.ac.uk
authors.forename: A R
authors.initials: AR
authors.lastname: Barclay
authors.forename: L M
authors.initials: LM
authors.lastname: Beattie
authors.forename: L T
authors.initials: LT
authors.lastname: Weaver
authors.forename: D C
authors.initials: DC
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000379:methods*; D005767:Gastrointestinal Diseases / Q000150:complications / Q000628:therapy*; D006801:Humans; D007223:Infant; D007422:Intestines / Q000601:surgery*; D010288:Parenteral Nutrition / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome