Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation

Show full item record



Permalink

http://hdl.handle.net/10138/313760

Citation

Karila , K , Anttila , A , Iber , T , Pakarinen , M & Koivusalo , A 2019 , ' Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation ' , Journal of Pediatric Surgery , vol. 54 , no. 3 , pp. 460-464 . https://doi.org/10.1016/j.jpedsurg.2018.10.043

Title: Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation
Author: Karila, Kristiina; Anttila, Annaleena; Iber, Tarja; Pakarinen, Mikko; Koivusalo, Antti
Contributor: University of Helsinki, Children's Hospital
University of Helsinki, Lastenkirurgian yksikkö
University of Helsinki, Lastenkirurgian yksikkö
Date: 2019-03
Language: eng
Number of pages: 5
Belongs to series: Journal of Pediatric Surgery
ISSN: 0022-3468
URI: http://hdl.handle.net/10138/313760
Abstract: Background: Surgery for necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) is often complicated by intestinal failure (IF) and intestinal failure associated cholestasis (IFAC). Objective: Assessment of incidence, predictors, and mortality associated with IFAC in surgically treated NEC and SIP. Methods: 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 mu mo1/1 (2.0 mg/dl) for >= two postoperative weeks while receiving parenteral nutrition (PN). Results: 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. Conclusions: 42% of pre matures 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. Type of study: Retrospective prognosis study. (C) 2018 Elsevier Inc. All rights reserved.
Subject: Necrotizing enterocolitis
Spontaneous intestinal perforation
Parenteral nutrition
Intestinal failure
Intestinal failure associated cholestasis
NUTRITION-ASSOCIATED CHOLESTASIS
LOW-BIRTH-WEIGHT
PARENTERAL-NUTRITION
LIVER-DISEASE
INFANTS
MANAGEMENT
3123 Gynaecology and paediatrics
3126 Surgery, anesthesiology, intensive care, radiology
Rights:


Files in this item

Total number of downloads: Loading...

Files Size Format View
1_s2.0_S0022346818306663_main.pdf 233.1Kb PDF View/Open

This item appears in the following Collection(s)

Show full item record