NUTRITION AND NEURODEVELOPMENTAL OUTCOMES AMONG A COHORT OF NEONATES WITH INTESTINAL FAILURE AND/OR SURGICAL SHORT BOWEL SYNDROME Public
Adams-Chapman, Ira (2011)
Published
Abstract
Background: Currently, there are limited data evaluating the relationship between prolonged parenteral nutrition in neonates with gastrointestinal complications and predictors of death or long term nutritional outcome.
Objective: To identify factors associated with failure to achieve enteral autonomy in a cohort of neonates from a single center at risk for intestinal failure
Methods: A retrospective chart review was performed of patients with intestinal failure (defined as parenteral nutrition > 60 days) born between April 1, 2004 and July 30, 2009 from a single center Level III NICU. Primary endpoints were death or enteral autonomy (EA) is defined as reaching full feeds 365 days. Analyses were performed to evaluate differences in demographic, clinical, laboratory and nutritional outcome data and outcome status using SPSS statistical software.
Results: Eighty patients met criteria for IF during the study period, of whom 60% were male and the mean birth weight and gestation age was 1.48 .88 kg and 30.2 4.6 weeks, respectively. Sixty three (78.8%) infants survived and 4 (5%) received a small bowel/liver transplant. Patient diagnoses included Necrotizing enterocolitis (64%), abdominal wall defects (10.1%) and small bowel atresia (10%).
Overall, 60% of infants reached EA by 365 days; however, only 41% had reached full enteral feeds by 6 months of age. Peak serum AST levels (508 v. 324, p<.004) and days of parental nutrition and intralipid days (620 days v. 154 days, p< .000) were significantly higher among those who did not reach EA. Patients in both groups had similar peak serum levels of direct bilirubin and ALT. Patients who failed to reach EA were more likely to die. The percentage of eligible infants with IF who achieved EA increased with increasing birth year cohort. Conclusion: The primary endpoints of death or EA were both associated with days of exposure to parenteral nutrition. Peak liver function studies were not consistently associated with delay in achieving EA or prolonged exposure to parenteral nutrition.
Table of Contents
Table of Contents Chapter I: Introduction Statement of the Problem 1 Chapter II: Review of the Literature Necrotizing Enterocolitis Short Bowel Syndrome and Necrotizing Enterocolitis Nutrition and Necrotizing Enterocolitis Neurodevelopmental Outcome and Necrotizing Enterocolitis Project Justification and Public Health Implications 3 5 5 7 10 Chapter III: Methodology Hypotheses Specific Aims Study Design Study Population Data Collection and Data Management Study Definitions IRB Approval Statistical Analysis Study Limitation/Delimitations Ethics of Research 13 13 14 15 15 18 19 19 20 20 Chapter IV: Results Study Population Nutritional Outcome Neurodevelopmental Outcome 21 22 22 Chapter V: Conclusions Discussion and Future Directions 24 Figures 29 Tables 34
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NUTRITION AND NEURODEVELOPMENTAL OUTCOMES AMONG A COHORT OF NEONATES WITH INTESTINAL FAILURE AND/OR SURGICAL SHORT BOWEL SYNDROME () | 2018-08-28 13:52:16 -0400 |
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