title: The impact of multi-disciplinary intestinal rehabilitation programs on the outcome of pediatric patients with intestinal failure: a systematic review and meta-analysis.
abstract: BACKGROUND
  Pediatric intestinal failure (IF) is a complex clinical problem requiring coordinated multi-disciplinary care. Our objective was to review the evidence for the benefit of intestinal rehabilitation programs (IRP) in pediatric IF patients.
  
  
  METHODS
  A systematic review was performed on Medline (1950-2012), Pubmed (1966-2012), and Embase (1980-2012) conference proceedings and trial registries. The terms short bowel syndrome, intestinal rehabilitation, intestinal failure, patient care teams, and multi-disciplinary teams were used. Fifteen independent studies were included. Three studies that were cohort studies, including a comparison group, were included in a meta-analysis.
  
  
  RESULTS
  Compared to historical controls (n=103), implementation of an IRP (n=130) resulted in a reduction in septic episodes (0.3 vs. 0.5 event/month; p=0.01) and an increase in overall patient survival (22% to 42%). Non-significant improvements were seen in weaning from PN (RR=1.05, 0.88-1.25, p=0.62), incidence of IFALD (RR=0.2, 0-17.25, p=0.48), and relative risk of liver transplantation (3.99, 0.75-21.3, p=0.11). Other outcomes reported included a reduction in calories from parenteral nutrition (100% to 32%-56%), earlier surgical/transplant evaluation, and improved coordination of patient care.
  
  
  CONCLUSIONS
  For pediatric IF patients, IRPs are associated with reduced morbidity and mortality. Standardized clinical practice guidelines are necessary to provide uniform patient care and outcome assessment.
authors.affiliation: Group for Improvement of Intestinal Function and Treatment, The Hospital for Sick Children, University of Toronto, Ontario M5G 1X8, Canada.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Stanger
authors.forename: Carol
authors.initials: C
authors.lastname: Oliveira
authors.forename: Christopher
authors.initials: C
authors.lastname: Blackmore
authors.forename: Yaron
authors.initials: Y
authors.lastname: Avitzur
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
mesh_terms: D002648:Child; D002779:Cholestasis / Q000209:etiology / Q000401:mortality; D004065:Digestive System Abnormalities / Q000534:rehabilitation* / Q000601:surgery; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D006801:Humans; D033183:Interdisciplinary Communication; D007422:Intestines / Q000637:transplantation; D017093:Liver Failure / Q000209:etiology / Q000401:mortality; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000706:statistics & numerical data; D057947:Parenteral Nutrition Solutions / Q000009:adverse effects; D010348:Patient Care Team; D012107:Research Design; D012189:Retrospective Studies; D012306:Risk; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D012778:Short Bowel Syndrome / Q000534:rehabilitation* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D057947:Parenteral Nutrition Solutions