Predictors of 1‐year enteral autonomy in children with intestinal failure: A descriptive retrospective cohort study

Introduction

The International Intestinal Failure registry (IIFR) is an international consortium to study intestinal failure (IF) outcomes in a large contemporary pediatric cohort. We aimed to identify predictors of early (1‐year) enteral autonomy.

Methods

We included IIFR pilot phase patients. IF was defined by parenteral nutrition need for at least 60 days due to a primary gastrointestinal etiology. The primary outcome was time to enteral autonomy achievement. We built a mixed‐effects Weibull accelerated failure time model with random effects by center to analyze variables associated with enteral autonomy achievement.

Results

We included 189 patients (82% with short bowel syndrome) representing 11 international centers. Cumulative incidence of early enteral autonomy was 51.6% and death was 6.5%. In multivariable analysis, ostomy presence (TR 2.63, 95% CI 1.41 – 4.90) was associated with increased time to enteral autonomy achievement while Asian/Indian (TR 0.28, 95% CI 0.10 – 0.81) and Pacific Islander race (TR 0.34, 95% CI 0.13 – 0.90) were associated with decreased time to enteral autonomy achievement. In a second model in the subset with measured percent bowel length remaining, ostomy presence (TR 4.21, 95% CI 1.90 – 9.33) was associated with increased time to enteral autonomy achievement while greater percent bowel remaining (TR 0.96, 95% CI 0.94 – 0.98) was associated with decreased time to enteral autonomy achievement.

Conclusions

Minimizing bowel resection at initial surgery and establishing bowel continuity by ostomy reversal can effectively decrease the time to early enteral autonomy achievement in children with IF.

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