Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study.
OBJECTIVE
In a large cohort of children with intestinal failure (IF), we sought to determine the cumulative incidence of achieving enteral autonomy and identify patient and institutional characteristics associated with enteral autonomy.


METHODS
A multicenter, retrospective cohort analysis from the Pediatric Intestinal Failure Consortium was performed. IF was defined as severe congenital or acquired gastrointestinal diseases during infancy with dependence on parenteral nutrition (PN) >60 days. Enteral autonomy was defined as PN discontinuation >3 months.


RESULTS
A total of 272 infants were followed for a median (IQR) of 33.5 (16.2-51.5) months. Enteral autonomy was achieved in 118 (43%); 36 (13%) remained PN dependent and 118 (43%) patients died or underwent transplantation. Multivariable analysis identified necrotizing enterocolitis (NEC; OR 2.42, 95% CI 1.33-4.47), care at an IF site without an associated intestinal transplantation program (OR 2.73, 95% CI 1.56-4.78), and an intact ileocecal valve (OR 2.80, 95% CI 1.63-4.83) as independent risk factors for enteral autonomy. A second model (n = 144) that included only patients with intraoperatively measured residual small bowel length found NEC (OR 3.44, 95% CI 1.36-8.71), care at a nonintestinal transplantation center (OR 6.56, 95% CI 2.53-16.98), and residual small bowel length (OR 1.04 cm, 95% CI 1.02-1.06 cm) to be independently associated with enteral autonomy.


CONCLUSIONS
A substantial proportion of infants with IF can achieve enteral autonomy. Underlying NEC, preserved ileocecal valve, and longer bowel length are associated with achieving enteral autonomy. It is likely that variations in institutional practices and referral patterns also affect outcomes in children with IF.
Boston Children's Hospital, Boston, MA.
Faraz A
FA
Khan
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA.
Robert H
RH
Squires
Boston Children's Hospital, Boston, MA.
Heather J
HJ
Litman
Nationwide Children's Hospital, Columbus, OH.
Jane
J
Balint
Texas Children's Hospital, Houston, TX.
Beth A
BA
Carter
Boston Children's Hospital, Boston, MA.
Jeremy G
JG
Fisher
Seattle Children's Hospital, Seattle, WA.
Simon P
SP
Horslen
Boston Children's Hospital, Boston, MA.
Tom
T
Jaksic
Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Samuel
S
Kocoshis
Monroe Carrell Jr. Children's Hospital, Nashville, TN.
J Andres
JA
Martinez
Children's Hospital and Medical Center, Omaha, NE.
David
D
Mercer
University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA.
Susan
S
Rhee
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA.
Jeffrey A
JA
Rudolph
Children's Hospital Colorado Medical Center, Denver, CO.
Jason
J
Soden
Duke Children's Hospital and Health Center, Durham, NC.
Debra
D
Sudan
Children's Memorial Hospital, Chicago, IL.
Riccardo A
RA
Superina
Mott's Children's Hospital, Ann Arbor, MI.
Daniel H
DH
Teitelbaum
Mattel Children's Hospital University of California, Los Angeles, Los Angeles, CA.
Robert
R
Venick
Hospital for Sick Children, Toronto, Ontario, Canada.
Paul W
PW
Wales
Boston Children's Hospital, Boston, MA. Electronic address: christopher.duggan@childrens.harvard.edu.
Christopher
C
Duggan
D002170:Canada / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007080:Ileocecal Valve; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000453:epidemiology / Q000628:therapy*; D007422:Intestines / Q000637:transplantation; D008297:Male; D015999:Multivariate Analysis; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology