Long-term outcomes of pediatric intestinal failure
Long-term outcomes of pediatric intestinal failure
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DOI：
10.1053/j.sempedsurg.2017.09.006
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发表时间：
2017-10-01
影响因子：
1.7
通讯作者：
Jaksic, Tom
中科院分区：
文献类型：
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作者：
Fullerton, Brenna S.;Hong, Charles R.;Jaksic, Tom
近几十年来，儿科肠衰竭的管理不断发展，自从专业的多学科肠衰竭中心出现以来，生存率有所提高。虽然败血症和肠衰竭相关的肝脏疾病仍然导致死亡，但我们现在有越来越多的关于这一人群长期结局的数据。虽然肠道适应和肠外营养的断奶是最快的第一年期间的肠外支持，实现肠内自主性是可能的，即使在许多年后的能量和蛋白质的需求显着下降，随着年龄的增长。肠移植是发生长期肠外营养并发症的患者的一种选择，这些患者预计会出现永久性肠衰竭，但免疫抑制相关并发症会阻碍结局。大部分可用数据来自单中心回顾性报告，具有可变的纳入标准、肠衰竭定义和随访持续时间;这限制了分析结局和确定最佳实践的能力。由于大多数儿童现在都能长期存活，管理的重点已经转移到避免和管理合并症，支持正常生长和发育，以及优化这些医学和手术复杂患者的生活质量。(C)2017爱思唯尔公司All rights reserved.
Management of pediatric intestinal failure has evolved in recent decades, with improved survival since the advent of specialized multidisciplinary intestinal failure centers. Though sepsis and intestinal failure associated liver disease still contribute to mortality, we now have growing data on the long-term outcomes for this population. While intestinal adaptation and parenteral nutrition weaning is most rapid during the first year on parenteral support, achievement of enteral autonomy is possible even after many years as energy and protein requirements decline dramatically with age. Intestinal transplant is an option for patients experiencing complications of long-term parenteral nutrition who are expected to have permanent intestinal failure, but outcomes are hindered by immunosuppression-related complications. Much of the available data comes from single center retrospective reports, with variable inclusion criteria, intestinal failure definitions, and follow-up durations; this limits the ability to analyze outcomes and identify best practices. As most children now survive long-term, the focus of management has shifted to the avoidance and management of comorbidities, support of normal growth and development, and optimization of quality of life for these medically and surgically complex patients. (C) 2017 Elsevier Inc. All rights reserved.