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Chen CB, Chugh S, Fujiki M, Radhakrishnan K. Overview of Physical, Neurocognitive, and Psychosocial Outcomes in Pediatric Intestinal Failure and Transplantation. Curr Gastroenterol Rep 2022; 24:145-155. [PMID: 36040624 DOI: 10.1007/s11894-022-00848-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Intestinal failure and transplantation may significantly impact physical, neurocognitive, and psychosocial development in pediatric patients. Currently, there is a paucity of literature on the effects of intestinal failure and transplantation on these aspects of development. This article will review the current literature and discuss the short and long-term impacts as well as interventions to improve clinical outcomes in children with intestinal failure or those undergoing transplantation. RECENT FINDINGS Psychological disorders, neurodevelopmental delay, and social maladaptation are frequently encountered in this patient population. While the main focus is often on medical management, equal emphasis should be placed on other aspects of development such as increasing social support and improving school performance. The transition to adulthood also presents many obstacles for patients and healthcare providers should anticipate challenges such as childbirth, employment, and raising a family. The pre-operative, perioperative, and post-operative periods all represent opportunities for medical intervention. Frequent monitoring of physical, psychosocial, and neurocognitive status helps to improve clinical outcomes and long-term quality of life. Future research should emphasize continued development of multidisciplinary programs and specialized services to help address the physical and psychosocial needs of children with intestinal failure as well as transplant recipients.
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Affiliation(s)
- Charles B Chen
- Department of Child Health, University of Missouri School of Medicine, 400 N. Keene St, 65201, Columbia, MO, USA.
| | - Shreeya Chugh
- Department of Child Health, University of Missouri School of Medicine, 400 N. Keene St, 65201, Columbia, MO, USA
| | - Masato Fujiki
- Center for Gut Rehabilitation and Transplantation, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, 44195, Cleveland, OH, USA
| | - Kadakkal Radhakrishnan
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, 9500 Euclid Ave, 44195, Cleveland, OH, USA
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Posfay-Barbe KM, Barbe RP, Wetterwald R, Belli DC, McLin VA. Parental functioning improves the developmental quotient of pediatric liver transplant recipients. Pediatr Transplant 2013; 17:355-61. [PMID: 23586400 DOI: 10.1111/petr.12080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 11/29/2022]
Abstract
Psychomotor development in pediatric liver transplant (LT) recipients depends on several factors. Our aim was to evaluate the importance of parental involvement and family dynamics on psychomotor development by assessing (i) children and parents individually, (ii) the parent-child relationship, and (iii) the correlation between parental functioning and patient outcome, all before and after LT. Age-appropriate scales were used before and after LT. Twenty-one patients, 19 mothers, and 16 fathers were evaluated. Developmental quotient (DQ): No subjects scored in the "very good" range. The proportion of children with deficits increased from LT to two yr: 17.6% vs. 28.6%. Subjects 0-2 yr were more likely to have normal DQ at transplant (66.7% vs. 50% for older children). Abnormal DQ was more prevalent two yr post-LT in children older at LT (p = 0.02). The mother-child relationship was normal in 59% of families pre-LT and in 67% at two yr. The relationship was more favorable when the child received a transplant as an infant (p = 0.014 at 12 months post-LT). Normal DQ was associated with higher maternal global functioning score pre-LT (p = 0.03). Paternal performance scores were higher than maternal scores. Children transplanted after two yr of age suffer greater long-term deficits than those transplanted as infants.
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Affiliation(s)
- Klara M Posfay-Barbe
- Department of Pediatrics, Children's Hospital of Geneva, University Hospitals of Geneva, 6 Rue Willy-Donzé, Geneva, Switzerland.
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Shellmer DA, DeVito Dabbs A, Dew MA, Terhorst L, Noll RB, Kosmach-Park B, Mazariegos G. Adaptive functioning and its correlates after intestine and liver transplantation. Pediatr Transplant 2013; 17:48-54. [PMID: 23134290 PMCID: PMC3708469 DOI: 10.1111/petr.12011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2012] [Indexed: 12/01/2022]
Abstract
In this cross-sectional study, we compared levels of adaptive functioning and examined potential correlates of adaptive functioning in 18 pediatric intestine (ITX) and 22 liver (LTX) recipients transplanted between June 2003 and March 2009. Family caregivers completed the ABAS-II scale and provided socio-demographic information regarding recipients' age at transplantation, gender, ethnicity, time since transplantation, and caregivers' role, ethnicity, education, and family income. Overall adaptive functioning and all three adaptive functioning subdomain scores were significantly lower in ITX patients compared with LTX patients (p ≤ 0.04) and compared with the general population normative mean (p ≤ 0.003). Significant correlates of adaptive functioning after abdominal transplant included type of transplant procedure (r = -0.4, p = 0.02), gender (r = 0.4, p = 0.01), and educational level of caregiver (r = 0.5, p = 0.003) and together explained 45% of the variance in overall adaptive functioning. Findings provide new information regarding everyday functioning outcomes of ITX patients, add to existing data regarding non-medical outcomes for LTX patients, and highlight the need for ongoing monitoring and intervention following transplantation to enhance outcomes.
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Affiliation(s)
- Diana A. Shellmer
- Department of Pediatric Transplant Surgery, School of Medicine University of Pittsburgh, Pittsburgh, PA,Hillman Center for Pediatric Transplantation, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Annette DeVito Dabbs
- Department of Acute and Tertiary Care Nursing, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology and Biostatistics, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Terhorst
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Robert B. Noll
- Department of Pediatrics, School of Medicine, University of Pittsburgh, The Children's Hospital of Pittsburgh of UPMC
| | - Beverly Kosmach-Park
- Hillman Center for Pediatric Transplantation, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - George Mazariegos
- Department of Pediatric Transplant Surgery, School of Medicine University of Pittsburgh, Pittsburgh, PA,Hillman Center for Pediatric Transplantation, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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Approach to optimizing growth, rehabilitation, and neurodevelopmental outcomes in children after solid-organ transplantation. Pediatr Clin North Am 2010; 57:539-57, table of contents. [PMID: 20371051 DOI: 10.1016/j.pcl.2010.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One of the most critical differences between the posttransplant care of children and adults is the requirement in children to maintain a state of health that supports normal physical and psychological growth and development. Most children with organ failure have some degree of growth failure and developmental delay, which is not quickly reversed after successful transplantation. The challenge for clinicians caring for these children is to use strategies that minimize these deficits before transplantation and provide maximal opportunity for recovery of normal developmental processes during posttransplant rehabilitation. The effect of chronic organ failure, frequently complicated by malnutrition, on growth potential and cognitive development is poorly understood. This review presents a summary of what is known regarding risk factors for suboptimal growth and development following solid-organ transplant and describe possible strategies to improve these outcomes.
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Editorial comment: life after transplantation. Curr Opin Organ Transplant 2009; 14:504-6. [PMID: 19644369 DOI: 10.1097/mot.0b013e328330b6a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thevenin DM, Baker A, Kato T, Tzakis A, Fernandez M, Dowling M. Neuodevelopmental Outcomes for Children Transplanted Under the Age of 3 Years. Transplant Proc 2006; 38:1692-3. [PMID: 16908250 DOI: 10.1016/j.transproceed.2006.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Our previous investigations on neurodevelopmental outcomes for intestinal transplanted infants revealed that while some children were able to achieve a normal developmental outcomes, most children suffered from significant motor delays and several experienced severe cognitive delays. In our current investigation, we were especially interested in children who are transplanted before the age of 3 years because the impact of the chronic illness and nutrition impairment on the infant's developing brain may be more severe than those children who receive a liver transplant. METHODS We evaluated 34 infants using the Bayley Scales of Infant Development. Twenty-seven children received a liver/intestine or multivisceral transplant and seven received a liver transplant. RESULTS Comparison of the two groups revealed that children receiving an intestine/multivisceral transplant have much poorer outcomes. Seventy-four percent of these children were significantly delayed mentally compared to only 57.14% of the liver transplant infants. Furthermore, 42.86% of the liver-transplanted infants were actually functioning in the normal range posttransplant. The intestinal/multivisceral transplant infants' motor development shows the most striking difference, with 96.3% being severely delayed as compared to liver transplant infants in whom only 71% experienced serious delays. The neurodevelopmental impact of organ failure and transplant before the age of 3 years may depending on the type of organ transplant. Our study found that it may be more likely to expect a good outcome for liver transplant patients than for intestinal and multivisceral transplanted infants. This difference maybe due to the overall severity of the disease and the possible impact of nutritional deficits early in infancy.
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Affiliation(s)
- D M Thevenin
- Department of Pediatrics, UMMG Physician-Patient Advocacy Program, University of Miami/Miller School of Medicine, Miami, FL 33101, USA.
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Thevenin DM, Baker A, Kato T, Tzakis A, Fernandez M, Dowling M. Neurodevelopmental Outcomes of Infant Multivisceral Transplant Recipients: A Longitudinal Study. Transplant Proc 2006; 38:1694-5. [PMID: 16908251 DOI: 10.1016/j.transproceed.2006.05.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED This longitudinal investigation compares cognitive and physical capabilities of transplant recipients, both before and after receiving an intestinal transplant. METHODS Using the Bayley Scales of Infant Development, we conducted pretransplant and posttransplant assessments on nine children (4 males, 5 females) who received either an isolated intestine, combined intestine and liver, or multivisceral transplants, with a mean age at transplant of 18 months (range 8-29) and a mean time posttransplant of 2 months (range 1-4 months). RESULTS Scores on the Mental Developmental Index reflected that a majority (55.6%) of patients who scored in the significantly delayed range prior to transplant remained in the significantly delayed classification after receiving a transplant. In addition, 33.3% showed a decrease in their mental classification; either from "mildly delayed" to "significantly delayed" or from "within normal limits" to "mildly delayed". Results on the Motor Developmental Index demonstrated that 78% of recipients had significant delays both before and after receiving a transplant, while 11.1% fell one standard deviation after transplantation. We found that the majority of children who experience developmental delays prior to transplant are still experiencing delays when they are discharged from inpatient care. In addition, those children receiving multivisceral transplantations, as opposed to an isolated bowel, may be at a much greater risk of developing and retaining both cognitive and physical delays. Early neurodevelopmental evaluations of these patients is essential for early parental education and compliance with early intervention services to maximize potential recovery and ability to obtain normal development.
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Affiliation(s)
- D M Thevenin
- Department of Pediatrics, UMMG Physician-Patient Advocacy Program, University of Miami/Miller School of Medicine, Miami, FL 33101, USA.
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