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Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation
| Content Provider | Scilit |
|---|---|
| Author | Karila, Kristiina Anttila, Annaleena Iber, Tarja Pakarinen, Mikko Koivusalo, Antti |
| Copyright Year | 2019 |
| Description | Journal: Journal of pediatric surgery Surgery for necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) is often complicated by intestinal failure (IF) and intestinal failure associated cholestasis (IFAC). Assessment of incidence, predictors, and mortality associated with IFAC in surgically treated NEC and SIP. A retrospective observational study based on hospital records during 1986-2014 in the two largest Finnish neonatal intensive care units was performed. IFAC was defined as conjugated bilirubin >34 μmol/l (2.0 mg/dl) for ≥ two postoperative weeks while receiving parenteral nutrition (PN). In total 225 patients underwent surgery for NEC (n = 142; 63%) or SIP (n = 83; 37%). Included were 57 survivors with ≥two weeks PN. Sixty-five (42%) patients developed IFAC. Two-year survival with IFAC was 80% and without IFAC 89% (p = 0.13). Of the 65 patients with IFAC, all eight with unresolved IFAC died in comparison to six of 57 (11%) whose IFAC resolved (p < 0.0001), while IFAC resolved in all survivors. Survival among patients with resolved IFAC was 89% and with unresolved IFAC (n = 8) 0%, (p < 0.0001). IFAC lasted for median 83 (IQR 45-120) days and correlated with the duration of PN (R2 = 0.16, p = 0.03), delay of starting enteral feeds (R2 = 0.12, p = 0.05) and PN lipid emulsion (RR = 1.0 (95% CI = 1.0-1.1) (p = 0.02). In multivariate logistic regression analysis, IFAC development associated with septicemias and reoperations. 42% of prematures who underwent surgery for NEC or SIP developed IFAC. Reoperations and septicemias increased the risk of IFAC. None of the patients with unresolved IFAC survived, but IFAC did not increase overall mortality. Retrospective prognosis study. Level II. |
| Related Links | https://helda.helsinki.fi/bitstream/10138/313760/1/1_s2.0_S0022346818306663_main.pdf |
| Ending Page | 464 |
| Page Count | 5 |
| Starting Page | 460 |
| ISSN | 00223468 |
| e-ISSN | 15315037 |
| DOI | 10.1016/j.jpedsurg.2018.10.043 |
| Journal | Journal of pediatric surgery |
| Issue Number | 3 |
| Volume Number | 54 |
| Language | English |
| Publisher | Elsevier BV |
| Publisher Date | 2019-03-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Journal of pediatric surgery Pediatrics and Child Health Intestinal Failure Intestinal Failure Associated Cholestasis Necrotizing Enterocolitis Parenteral Nutrition Spontaneous Intestinal Perforation |
| Content Type | Text |
| Resource Type | Article |
| Subject | Surgery Pediatrics, Perinatology and Child Health |
