Coordinated interdisciplinary management of pediatric intestinal failure: A 2-year review

Background/Purpose: intestinal failure is a complex metabolic process that results from malabsorption and malnutrition and provides challenges for a v ariety of pediatric subspecialists. The purpose of this study was to evalua te the effect of coordinated interdisciplinary team management of children with intestinal failure on nutritional outcome measures. Methods: The Intestinal Care Center (ICC) is staffed with an interdisciplin ary team of pediatric specialists including a gastroenterologist, pediatric surgeon, transplant surgeon, clinical dietitians, and a nutrition support nurse. Using an established registry, the authors conducted a comprehensive evaluation of patient data including anthropometric measures, organ system function, and mode of nutrition support. Disease-associated complications including micronutrient deficiencies, growth delay and death also were moni tored. Nutritional outcome was assessed by transition from enteral to oral feeding, cessation of total parenteral nutrition (TPN), and maintenance of linear growth. Results: Since the inception of the ICC in 1996, 103 patients (69 boys, 34 girls) with intestinal failure have been evaluated with a median age of 2.6 years (range, 0.2 to 21.3 years). Mode of nutritional therapy on initial c onsultation included TPN (n = 76, 74%), enteral feedings (n = 6, 6%) and or al intake (n = 21, 20%). After intensive management of the 76 patients who were TPN dependent, 22 (29%) subsequently have been weaned from TPN (durati on, 0.2 to 17.5 years) to oral (n = 14), oral-enteral (n = 4) or enteral fe edings (n = 4). Of the 6 patients who were receiving enteral feedings, 4 (6 7%) were transitioned to oral feedings. Sixty-eight patients (66%) had evid ence of hepatic disease. Of these, 10 underwent transplant, and 23 died (2 posttransplant). Linear growth velocity of neither pre- nor postpubescent p atients significantly improved during the 2-year study period. Conclusion: Data registry establishment and concurrent interdisciplinary te am management of children with intestinal failure provides for innovative t reatment approaches and a foundation for retrospective or prospective asses sment of children with disease. J Pediatr Surg 35:380-385. Copyright (C) 20 00 by W.B. Saunders Company.