Elsevier

The Journal of Pediatrics

Volume 153, Issue 5, November 2008, Pages 674-676.e2
The Journal of Pediatrics

Original article
Neonatal Onset Intestinal Failure: An Italian Multicenter Study

https://doi.org/10.1016/j.jpeds.2008.05.017Get rights and content

Objective

To describe the natural course of intestinal failure with onset in the neonatal period to provide data regarding the occurrence and to provide a population-based survey regarding the spectrum of underlying diseases.

Study design

We performed a retrospective chart review including infants admitted to the neonatal intensive care unit of 7 Italian tertiary care centers. Intestinal failure was defined as a primary intestinal disease that induces the need of total parenteral nutrition (PN) for more than 4 weeks or the need of partial PN for more than 3 months.

Results

The total number of live births during the study time within the enrolled institutions was 30 353, and the number of newborns admitted to the neonatal intensive care unit was 5088. Twenty-six patients satisfied the definition of intestinal failure; thus the occurrence rate of intestinal failure was 0.1% among live-birth newborns and 0.5% among infants at high risk. The main underlying diseases leading to intestinal failure in neonatal age were congenital intestinal defects (42.3%), necrotizing enterocolitis (30.8%), severe intestinal motility disorder (11.5%), intestinal obstruction (7.7%), structural enterocyte defects (3.8%), and meconium peritonitis (3.8%). After a follow-up of 36 months, 84.6% of patients achieved intestinal competence, 1 patient was still receiving home PN, 1 patient underwent transplantation, and 2 patients died. Cholestatic liver disease was diagnosed in 54% of observed children.

Conclusion

An understanding of the incidence, causes, and natural history of intestinal failure would be helpful to appropriately allocate resources and to plan clinical trials.

Section snippets

Methods

A multicenter, nationwide, retrospective study was planned in collaboration with the Italian Society of Pediatric Gastroenterology Hepatology and Nutrition and with the Italian Society of Neonatology. Clinical charts of all newborns observed in Italian tertiary center neonatal intensive care units (NICU) during the years 2003 and 2004 were reviewed. Participating centers were selected on the basis of reported characteristics: ability to take care of high-risk pregnancy and of critically ill

Results

The total number of live births in the 7 enrolled institutions was 30 353 newborns, and 5088 were admitted to the NICU. Twenty-six patients met the criteria for intestinal failure and were included in the study (gestational age: 32.0 weeks, IQR 27.7-35.2; birth weight: 1865.0 g, IQR: 867.5-2262.5). The occurrence rate of intestinal failure was 0.1% (1:1077) and 0.5% (1:196) considering all live-birth newborns and high-risk infants, respectively.

Main demographic and clinical characteristics are

Discussion

The average incidence of intestinal failure is a 1 in 200 NICU admission. Although improved technologies and expertise have led to better outcomes, complications of long-term PN such as progressive liver disease, sepsis, and loss of venous access still represent a major source of morbidity and death for PN-dependent infants. In this Italian cohort, the major underlying disorders leading to intestinal failure by congenital intestinal defects that require bowel surgery. Intestinal atresia and

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    Unfortunately, SBS was not defined beyond a need for parenteral nutrition support for malabsorption after gastrointestinal surgery with significant bowel resection.13 In 2008, the Italian Society of Paediatric Gastroenterology Hepatology and Nutrition and the Italian Society of Neonatology published data pooled from 7 tertiary neonatal intensive care units over 2003 and 2004.14 Short bowel syndrome was defined using the definition employed by our program (residual small bowel length less than 25% of that predicted for gestational age or the need for parenteral nutrition for more than 42 days after intestinal loss/surgery).

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The authors declare no conflicts of interest.

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