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Demirok A, Nagelkerke SCJ, Benninga MA, Jonkers-Schuitema CF, van Zundert SMC, Werner XW, Sovran B, Tabbers MM. Pediatric Chronic Intestinal Failure: Something Moving? Nutrients 2024; 16:2966. [PMID: 39275281 PMCID: PMC11397488 DOI: 10.3390/nu16172966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/25/2024] [Accepted: 08/28/2024] [Indexed: 09/16/2024] Open
Abstract
Pediatric chronic intestinal failure (PIF) is a rare and heterogeneous condition characterized by the inability of the patient's intestine to adequately absorb the required fluids and/or nutrients for growth and homeostasis. As a result, patients will become dependent on home parenteral nutrition (HPN). A MEDLINE search was performed in May 2024 with keywords "intestinal failure", "parenteral nutrition" and "pediatric". Different underlying conditions which may result in PIF include short bowel syndrome, intestinal neuromuscular motility disorders and congenital enteropathies. Most common complications associated with HPN are catheter-related bloodstream infections, catheter-related thrombosis, intestinal failure-associated liver disease, small intestinal bacterial overgrowth, metabolic bone disease and renal impairment. Treatment for children with PIF has markedly improved with a great reduction in morbidity and mortality. Centralization of care in specialist centers and international collaboration between centers is paramount to further improve care for this vulnerable patient group. A recently promising medical therapy has become available for children with short bowel syndrome which includes glucagon-like peptide 2, a naturally occurring hormone which is known to delay gastric emptying and induce epithelial proliferation. Despite advances in curative and supportive treatment, further research is necessary to improve nutritional, pharmacological and surgical care and prevention of complications associated with parenteral nutrition use.
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Affiliation(s)
- Aysenur Demirok
- Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Sjoerd C J Nagelkerke
- Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marc A Benninga
- Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Cora F Jonkers-Schuitema
- Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Suzanne M C van Zundert
- Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Xavier W Werner
- Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Bruno Sovran
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology Metabolism, Academic Medical Center, University of Amsterdam, 1105 BK Amsterdam, The Netherlands
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Emma Center for Personalized Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Merit M Tabbers
- Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, 1105 AZ Amsterdam, The Netherlands
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Lambe C, Talbotec C, Kapel N, Barbot-Trystram L, Brabant S, Nader EA, Pigneur B, Payen E, Goulet O. Long-term treatment with teduglutide: a 48-week open-label single-center clinical trial in children with short bowel syndrome. Am J Clin Nutr 2023; 117:1152-1163. [PMID: 37270289 DOI: 10.1016/j.ajcnut.2023.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Short bowel syndrome (SBS) is the main cause of intestinal failure in children. OBJECTIVES This single-center study evaluated the safety and efficacy of teduglutide in pediatric patients with SBS-associated intestinal failure (SBS-IF). METHODS Children with SBS followed at our center with ≥2 y on parenteral nutrition (PN) and with small bowel length <80 cm who had reached a plateau were consecutively included in the study. At baseline, participants underwent a clinical assessment including a 3-d stool balance analysis, which was repeated at the end of the study. Teduglutide was administered subcutaneously 0.05 mg/kg/d for 48 wk. PN dependence was expressed as the PN dependency index (PNDI), which is the ratio PN non-protein energy intake/REE. Safety endpoints included treatment-emergent adverse events and growth parameters. RESULTS Median age at inclusion was 9.4 y (range: 5-16). The median residual SB length was 26 cm (IQR: 12-40). At baseline, the median PNDI was 94% (IQR: 74-119), (median PN intake: 38.9 calories/kg/d, IQR: 26.1-48.6). At week 24, 24 (96%) children experienced a reduction of >20% of PN requirements with a median PNDI = 50% (IQR: 38-81), (PN intake: 23.5 calories/kg/d IQR: 14.6-26.2), P < 0.01. At week 48, 8 children (32%) were weaned completely off PN. Plasma citrulline increased from 14 μmol/L (IQR: 8-21) at baseline to 29 μmol/L (IQR: 17-54) at week 48 (P < 0.001). Weight, height, and BMI z-scores remained stable. The median total energy absorption rate increased from 59% (IQR: 46-76) at baseline to 73% (IQR: 58-81) at week 48 (P = 0.0222). Fasting and postprandial endogenous GLP-2 concentrations increased at weeks 24 and 48 compared with baseline. Mild abdominal pain at the early phase of treatment, stoma changes, and redness at the injection site were commonly reported. CONCLUSIONS Increased intestinal absorption and PN dependency reduction were observed with teduglutide treatment in children with SBS-IF. TRIAL REGISTRATION ClinicalTrials.gov NCT03562130. https://clinicaltrials.gov/ct2/show/NCT03562130?term=NCT03562130&draw=2&rank=1.
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Affiliation(s)
- Cécile Lambe
- Service de Gastro-entérologie et Nutrition pédiatrique, Université Paris Cité, Hôpital Necker-Enfants Malades, Paris.
| | - Cécile Talbotec
- Service de Gastro-entérologie et Nutrition pédiatrique, Université Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - Nathalie Kapel
- Laboratoire de Coprologie Fonctionnelle, Université Paris Sorbonne, Hôpital la Pitié-Salpétrière, Paris
| | - Laurence Barbot-Trystram
- Laboratoire de Coprologie Fonctionnelle, Université Paris Sorbonne, Hôpital la Pitié-Salpétrière, Paris
| | - Séverine Brabant
- Laboratoire des Explorations Fonctionnelles, Université Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - Elie Abi Nader
- Service de Gastro-entérologie et Nutrition pédiatrique, Université Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - Bénédicte Pigneur
- Service de Gastro-entérologie et Nutrition pédiatrique, Université Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - Elise Payen
- Service de Gastro-entérologie et Nutrition pédiatrique, Université Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - Olivier Goulet
- Service de Gastro-entérologie et Nutrition pédiatrique, Université Paris Cité, Hôpital Necker-Enfants Malades, Paris
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Cerdó T, García-Santos JA, Rodríguez-Pöhnlein A, García-Ricobaraza M, Nieto-Ruíz A, G. Bermúdez M, Campoy C. Impact of Total Parenteral Nutrition on Gut Microbiota in Pediatric Population Suffering Intestinal Disorders. Nutrients 2022; 14:4691. [PMID: 36364953 PMCID: PMC9658482 DOI: 10.3390/nu14214691] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 08/10/2023] Open
Abstract
Parenteral nutrition (PN) is a life-saving therapy providing nutritional support in patients with digestive tract complications, particularly in preterm neonates due to their gut immaturity during the first postnatal weeks. Despite this, PN can also result in several gastrointestinal complications that are the cause or consequence of gut mucosal atrophy and gut microbiota dysbiosis, which may further aggravate gastrointestinal disorders. Consequently, the use of PN presents many unique challenges, notably in terms of the potential role of the gut microbiota on the functional and clinical outcomes associated with the long-term use of PN. In this review, we synthesize the current evidence on the effects of PN on gut microbiome in infants and children suffering from diverse gastrointestinal diseases, including necrotizing enterocolitis (NEC), short bowel syndrome (SBS) and subsequent intestinal failure, liver disease and inflammatory bowel disease (IBD). Moreover, we discuss the potential use of pre-, pro- and/or synbiotics as promising therapeutic strategies to reduce the risk of severe gastrointestinal disorders and mortality. The findings discussed here highlight the need for more well-designed studies, and harmonize the methods and its interpretation, which are critical to better understand the role of the gut microbiota in PN-related diseases and the development of efficient and personalized approaches based on pro- and/or prebiotics.
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Affiliation(s)
- Tomás Cerdó
- Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, 14004 Córdoba, Spain
| | - José Antonio García-Santos
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Anna Rodríguez-Pöhnlein
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - María García-Ricobaraza
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Ana Nieto-Ruíz
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Mercedes G. Bermúdez
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
| | - Cristina Campoy
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain
- Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada’s Node, Carlos III Health Institute, Avda. Monforte de Lemos 5, 28028 Madrid, Spain
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Tran DL, Nguyen TK, Nguyen TTC, Le TTL, Tran CL, Le TG, Pham DT, Nguyen MP. Prevalence and eradication efficacy of Helicobacter pylori infection in children in the Mekong delta, Vietnam: a cross-sectional study. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e85554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Worldwide, Helicobacter pylori (HP) infection in children with peptic ulcer and/or gastritis (PUG) is increasingly common. In Vietnam, clinical symptoms of HP infection in PUG children are often non-specific, and treatment regimens currently have a low success rate.
Objective: This study determined the HP infection prevalence, its clinical and endoscopic findings, and its associated factors. Additionally, the efficiencies of HP treatment regimens in PUG children were also evaluated.
Design and setting: A cross-sectional descriptive study was conducted on 140 pediatric patients diagnosed with PUG at Can Tho Children’s Hospital from 2017–2019.
Results: The prevalence of HP infection in PUG children was 46.4%. A significant association was found between HP infection and patient possessing a family history of HP infection (aOR: 2.35 (1.1–4.76). Symptoms of abdominal pain accounted for the highest rate of 88.6%, followed by vomiting, heartburn, epigastric burning, and gastric bleeding (57.9%, 36.4%, 22.9%, and 13.6%, respectively). Endoscopic findings denoted that inflammatory lesions accounted for 85% and ulcers accounted for 15%. The successful HP eradication rate using the PAM regimen (Proton pump inhibitor/amoxicillin/metronidazole) was 51.8%, with 13.6% of PUG children encountering side effects.
Conclusion: PUG children have a high rate of HP infection. Clinical symptoms are often non-specific, in which abdominal pain is the most common symptom. The success of HP eradication by the standard guideline of the Vietnam Ministry of Health is quite low. Thus, critical adjustments in the regimens are necessary.
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Boctor DL, Jutteau WH, Fenton TR, Shourounis J, Galante GJ, Eicher I, Goulet O, Lambe C. The prevalence of feeding difficulties and potential risk factors in pediatric intestinal failure: Time to consider promoting oral feeds? Clin Nutr 2021; 40:5399-5406. [PMID: 34571239 DOI: 10.1016/j.clnu.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/14/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Although nutritional care is a cornerstone in the management of pediatric intestinal failure (IF), little is known about feeding difficulty (FD) prevalence. The aim of this study was to determine the frequency of FD and associated factors and to characterize eating behaviours in two pediatric IF rehabilitation centres (Hôpital-Necker Enfants Malades (NEM), France and Alberta Children's Hospital (ACH), Canada). METHODS Parents of children (aged 1-18 years) on home parenteral nutrition (PN) for >3 months followed at NEM and ACH completed two validated tools: Montreal Children's Feeding scale for severity of FD, Child Eating Behaviour Questionnaire and a pediatric IF-specific questionnaire for FD associated risk factors. RESULTS In the entire cohort (n = 59, median 5.2 years), 15% had mild, 19% had moderate and 25% had severe FD. No FD was seen in 53% vs 11% and severe FD was seen in 20% vs. 39% of the NEM and ACH cohorts respectively (p = 0.003). Current ETF was less common at NEM vs. ACH (3% vs. 50%, p < 0.001). The FD score was associated with current enteral tube feed (ETF) use (p = 0.04). Compared to healthy reference children, the NEM cohort did not differ for the enjoyment of food, whereas the ACH cohort's enjoyment was lower (p < 0.0001). The ACH cohort scored higher for food avoidance behaviours: food fussiness (p < 0.02), satiety responsiveness (p < 0.0001), and slowness in eating (p < 0.0001) while the NEM cohort was not different from healthy reference children. In the entire cohort, according to parental recall, 60% were reported to be NPO for >12 weeks in the first 6 months of life, and late introduction of purees (>9 months) and lumpy textures (>1 year) were found in 40% and 58%, respectively. Parent-recalled ETF differed between NEM and ACH in the first 6 months of life (45% vs 76%, p = 0.03). CONCLUSIONS Feeding difficulty and associated risk factors, including early ETF, prolonged NPO and delays in achieving feeding milestones were frequently reported in pediatric IF. Feeding medicalization with the use of ETF may inadvertently contribute to FD and eating disorder behavioural characteristics. This study highlights the need for FD prevention and an increased focus on establishing healthy eating. Future prospective study of FD, associated risk factors and clinical outcomes are merited.
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Affiliation(s)
- Dana Liza Boctor
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta Children's Hospital Calgary, 28 Oki Drive NW, Calgary, AB, T3B-6A8, Canada.
| | - Wiem Hassen Jutteau
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Digestive Diseases, Pediatric Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris Medical School, 149 Rue de Sèvres, 75015 Paris, France
| | - Tanis R Fenton
- Nutrition Services, Alberta Health Services, Department of Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jasmine Shourounis
- Alberta Children's Hospital, Nutrition Services, Alberta Health Services, 28 Oki Drive NW, Calgary, AB, T3B-6A8, Canada
| | - Gary Joshua Galante
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta Children's Hospital Calgary, 28 Oki Drive NW, Calgary, AB, T3B-6A8, Canada
| | - Isabelle Eicher
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Digestive Diseases, Pediatric Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris Medical School, 149 Rue de Sèvres, 75015 Paris, France
| | - Olivier Goulet
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Digestive Diseases, Pediatric Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris Medical School, 149 Rue de Sèvres, 75015 Paris, France
| | - Cecile Lambe
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Digestive Diseases, Pediatric Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris Medical School, 149 Rue de Sèvres, 75015 Paris, France
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Proli F, Faragalli A, Talbotec C, Bucci A, Zemrani B, Chardot C, Abi Nader E, Goulet O, Lambe C. Variation of plasma citrulline as a predictive factor for weaning off long-term parenteral nutrition in children with neonatal short bowel syndrome. Clin Nutr 2021; 40:4941-4947. [PMID: 34358840 DOI: 10.1016/j.clnu.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS Long-term parenteral nutrition (PN) is the mainstay of the therapeutic strategy in intestinal failure (IF) due to neonatal short bowel syndrome (SBS). Our aim was to identify prognostic factors for PN weaning and to assess if measuring plasma citrulline concentrations over time could account for the intestinal adaptation in progress. METHODS This retrospective study included children with neonatal SBS with surgical measurement of the residual bowel length and repeated plasma citrulline assessments during a 4-year follow-up. The degree of IF was assessed by the PN dependency index (PN caloric intake/Resting energy expenditure). The analysis was carried out according to SBS anatomical groups: end-jejunostomy (type 1), jejuno-colic (type 2) and jejuno-ileal anastomosis (type 3). RESULTS Fifty-five patients (8 type 1, 27 type 2, 20 type 3) were included. None of the patients with SBS type 1, 11 (41%) with type 2 and 11 (55%) with type 3 were weaned off during the follow-up period. Plasma citrulline levels significantly increased with time in patients who were finally weaned off PN; conversely, the levels did not consistently increase in patients who were still on PN at the end of the study period. There was an inverse relationship between plasma citrulline levels and the PN dependency index. The increasing citrulline levels had a positive effect on the probability of weaning, 2.7 times higher for each point increase in citrulline. No significant effect of age and residual bowel length at baseline was found. CONCLUSION The increased plasma citrulline level over time in addition to the SBS anatomical type is a reliable marker for subsequent PN weaning. The prediction of PN weaning assessed solely by the residual bowel length or a single measurement of citrulline is insufficient and should also take into account the anatomical type of SBS and repeated measurements of plasma citrulline levels.
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Affiliation(s)
- Francesco Proli
- Division of Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Intestinal Diseases, Intestinal Rehabilitation Center, Certified Center for Home Parenteral Nutrition, Hôpital Necker Enfants Malades, Université de Paris, Faculté de Médecine Paris-Descartes, France; Department of Pediatrics, Department of Woman, Child Health and Public Health, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
| | - Andrea Faragalli
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Pol. Delle Marche, Ancona, Italy
| | - Cécile Talbotec
- Division of Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Intestinal Diseases, Intestinal Rehabilitation Center, Certified Center for Home Parenteral Nutrition, Hôpital Necker Enfants Malades, Université de Paris, Faculté de Médecine Paris-Descartes, France
| | - Andrea Bucci
- Department of Economics, University G. D'Annunzio of Chieti-Pescara, Pescara, Italy
| | - Boutaina Zemrani
- Division of Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Intestinal Diseases, Intestinal Rehabilitation Center, Certified Center for Home Parenteral Nutrition, Hôpital Necker Enfants Malades, Université de Paris, Faculté de Médecine Paris-Descartes, France
| | - Christophe Chardot
- Pediatric Surgery, Hôpital Necker Enfants Malades, Université de Paris, Faculté de Médecine Paris-Descartes, France
| | - Elie Abi Nader
- Division of Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Intestinal Diseases, Intestinal Rehabilitation Center, Certified Center for Home Parenteral Nutrition, Hôpital Necker Enfants Malades, Université de Paris, Faculté de Médecine Paris-Descartes, France
| | - Olivier Goulet
- Division of Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Intestinal Diseases, Intestinal Rehabilitation Center, Certified Center for Home Parenteral Nutrition, Hôpital Necker Enfants Malades, Université de Paris, Faculté de Médecine Paris-Descartes, France
| | - Cécile Lambe
- Division of Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Intestinal Diseases, Intestinal Rehabilitation Center, Certified Center for Home Parenteral Nutrition, Hôpital Necker Enfants Malades, Université de Paris, Faculté de Médecine Paris-Descartes, France
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Mast Cells: Fascinating but Still Elusive after 140 Years from Their Discovery. Int J Mol Sci 2020; 21:ijms21020464. [PMID: 31940755 PMCID: PMC7013937 DOI: 10.3390/ijms21020464] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/21/2022] Open
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Cernat E, Puntis J. Paediatric parenteral nutrition: current issues. Frontline Gastroenterol 2019; 11:148-154. [PMID: 32133114 PMCID: PMC7043071 DOI: 10.1136/flgastro-2018-101127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 02/04/2023] Open
Abstract
Parenteral nutrition transformed the prognosis for infants and children with intestinal failure. Soon after its introduction into clinical care 50 years ago, parenteral nutrition was also rapidly adopted for use in the preterm infant, where immaturity of gastrointestinal motor function precluded enteral feeding. Preterm infants subsequently became the single largest group of patients to be fed in this way. Although the development of scientific knowledge and the lessons of clinical experience have reduced the risk of complications, some of the problems and difficulties associated with this form of nutritional support remain challenging. These include central venous catheter-related sepsis, thrombosis, liver disease, bone disease and metabolic disturbance. In an initiative to promote best practice, guidelines on parenteral nutrition were first published by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and collaborating organisations in 2005. These were constructed following a thorough review of the scientific literature, allowing a series of evidence-based recommendations to be made. The exercise was repeated just over 10 years later and updated guidelines published in 2018. This review summarises key elements from the new guideline, with a focus on what has changed since 2005.
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Affiliation(s)
- Elena Cernat
- Department of Paediatric Gastroenterology and Nutrition, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Puntis
- Department of Paediatric Gastroenterology and Nutrition, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Lauro A, Lacaille F. Short bowel syndrome in children and adults: from rehabilitation to transplantation. Expert Rev Gastroenterol Hepatol 2019; 13:55-70. [PMID: 30791840 DOI: 10.1080/17474124.2019.1541736] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Short bowel syndrome (SBS) is a dramatic clinical condition in both children and adults; the residual bowel length is not sufficient to avoid intestinal failure, with subsequent malnutrition and growth retardation, and intravenous support is required to provide the nutrients normally coming from the intestine. Apart from the primary disease, the medical status can be worsened by complications of intestinal failure: if there are irreversible, the prognosis is poor unless a successful intestinal rehabilitation is achieved. Areas covered: The rescue of the remnant small bowel requires a multidisciplinary expertise to achieve digestive autonomy. The use of intestinal trophic factors has shown encouraging results in improving the intestinal adaptation process. Whenever the residual bowel length is inadequate, in a well-selected population weaning parenteral nutrition (PN) off could be attempted by surgery through lengthening procedures. A further subset of patients, with total and irreversible intestinal failure and severe complications on PN, may have an indication to intestinal transplantation. This procedure is still affected by poor long-term results. Expert commentary: Novel approaches developed through a multidisciplinary team work, such as manipulation of microbiota or tissue bioengineering, should be added to current therapies to treat successfully SBS.
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Affiliation(s)
- Augusto Lauro
- a Emergency Surgery Department , St. Orsola University Hospital , Bologna , Italy
| | - Florence Lacaille
- b Gastroenterology Hepatology Nutrition Unit , Hôpital Necker-Enfants Malades , Paris , France
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Pediatric Intestinal Failure Review. CHILDREN-BASEL 2018; 5:children5070100. [PMID: 30037012 PMCID: PMC6069045 DOI: 10.3390/children5070100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/23/2023]
Abstract
The term, ‘intestinal failure’, signifies the inability of the body to meet the digestive, absorptive and nutritive needs of the body. As such, these individuals require parenteral nutrition (PN) for survival. The subsequent nutritional, medical and surgical facets to the care are complex. Improved care has resulted in decreased need for intestinal transplantation. This review will examine the unique etiologies and management strategies in pediatric patients with intestinal failure.
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