Elements of successful intestinal rehabilitation.
OBJECTIVE
The optimal therapy for intestinal failure (IF) is unknown. The results of a systematic, protocol-driven management strategy by a multidisciplinary team are described.


METHODS
Intestinal failure was defined as bowel length of less than 40 cm or parenteral nutrition (PN) for more than 42 days. A multidisciplinary team and protocol to prevent PN-associated liver disease (PNALD) were instituted in 2006. Data were gathered prospectively with consent and ethics board approval.


RESULTS
From 1998 to 2006, 33 patients were treated (historical cohort) with an overall survival of 72%. Rotating prophylactic antibiotics for bacterial overgrowth were given to 27% of patients; 6% had lipid-sparing PN, and none received fish oil-based lipids. Median time to intestinal rehabilitation was 7 ± 3.1 months, and 27% of patients who developed PNALD died. From 2006 to 2009, 31 patients were treated. Seventy-seven percent received PAB; 60%, lipid-sparing PN; and 47%, parenteral fish oil emulsion. Eighty-seven percent weaned from PN at 3.9 ± 3.8 months, and no patients developed PNALD with 100% survival. Novel lipid therapies were associated with changes in essential fatty acid profile and one case of clinical essential fatty acid deficiency.


CONCLUSIONS
The institution of a multidisciplinary team and a protocol-driven strategy to prevent PNALD improves survival in IF. Further studies are recommended.
Division of Pediatric General Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Canada. sigalet@ucalgary.ca
David
D
Sigalet
Dana
D
Boctor
Mary
M
Brindle
Viona
V
Lam
Marli
M
Robertson
D019072:Antibiotic Prophylaxis / Q000379:methods; D002779:Cholestasis / Q000209:etiology / Q000517:prevention & control; D002985:Clinical Protocols; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods; D004655:Emulsions / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005395:Fish Oils / Q000627:therapeutic use; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000209:etiology / Q000517:prevention & control; D008137:Longitudinal Studies; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010348:Patient Care Team / Q000458:organization & administration; D010743:Phospholipids / Q000627:therapeutic use; D011446:Prospective Studies; D012778:Short Bowel Syndrome / Q000534:rehabilitation* / Q000601:surgery / Q000628:therapy; D013024:Soybean Oil / Q000627:therapeutic use; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D010743:Phospholipids; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil