Incidence, predictors and outcome of neonatal-onset intestinal failure

TL;DR

This study estimates the incidence of neonatal intestinal failure in Queensland, identifies risk factors, and shows that most affected children eventually stop needing intravenous nutrition.

Contribution

Provides population-based incidence rates and identifies predictors of neonatal intestinal failure and short bowel syndrome.

Findings

The incidence of neonatal intestinal failure was 13.7 per 100,000 live births.

Shorter residual small bowel and absent colon were independent predictors of intestinal failure.

71% of children with intestinal failure achieved enteral autonomy, with longer residual bowel associated with success.

Abstract

Neonatal-onset Intestinal Failure (IF) and Short Bowel Syndrome (SBS) are associated with significant morbidity. We aimed to estimate incidence, identify predictors and determine outcomes of neonatal IF and SBS.

Retrospective review of children admitted to Queensland Children’s Hospital between April, 2018 to March, 2022 who received parenteral nutrition (PN) in the neonatal period. IF was defined as those who required PN> 60 days from a gastrointestinal cause. Population-based estimate of incidence was calculated using census data from the national bureau of statistics.

49 neonatal patients received PN, of which 21 had IF, including 16 with SBS. The population-based incidence of IF and SBS-IF were 13.7(95 % CI 10.0–17.1) and 10.51(95 % CI 5.04–15.59) per 100,000 live-births respectively. Those with IF had lower birth weight [1985(IQR 1321)g vs.3140(IQR778)g, p = 0.001], lower gestational age [34weeks(IQR7.5)vs.38weeks(IQR3),p = 0.001], shorter residual small bowel [45 cm(IQR44)vs.245 cm(IQR50),p = 0.001], more likely to have an enterostomy [17/21vs.10/28,p = 0.003] and no colon [10/21vs.3/28,p = 0.0001] compared to those without IF. On multivariate analysis, residual small bowel length [OR 0.73(95 %CI 0.57–0.93),p = 0.008] and absent colon [OR 0.84(95 %CI 0.69 – 0.92),p = 0.001] were independent predictors of IF. At follow-up, 71 % (15/21) of patients with IF, including 81 % (13/16) with SBS attained enteral autonomy with no mortality. Children who attained enteral autonomy had significantly longer residual bowel [47.5(IQR 33)cm. vs. 26 cm.,p = 0.04] as compared to those who remained on PN.

The population-based incidence of IF and SBS-IF in Queensland, Australia was 13.7 and 10.51 per 100,000 live-births respectively. Most children with neonatal IF achieve enteral autonomy with residual small bowel length predictive of it.

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