Clin Nutr ESPEN. 2025 Jan 17:S24054577(25)000348. doi:10.1016/j.clnesp.2025.01.033.Online ahead of print.

Heitor P Leite ¹, Rodrigo Vincenzi ², Carlos O Kieling ³, Paulo C Koch Nogueira ⁴, Roberta L Longo ⁵, Natalia C Person ⁶, Joao Seda Neto ⁷, Estela C Pavanelli ⁸, Catiana M Gritti ⁹, Mariana Jbm Fonseca ¹⁰, Maria Fernanda C de Camargo ¹¹, Camila P Genzani ¹², Eduardo F Hatanaka ¹³, Keilla McB Uchoa ¹⁴, Simone Mrm Perentel ¹⁵, Marina R Adami ¹⁶, Marilia R Ceza ¹⁷, Daltro LA Nunes ¹⁸, Berenice L Santos ¹⁹, Liege L Godoy ²⁰, Leticia Feldens ²¹, Helena As Goldani ²²

Author information

¹Department of Pediatrics, Universidade Federal de São Paulo, Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil. Electronic address: heitorpons@gmail.com.

²Intestinal Rehabilitation and Transplant Center, Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: rodrigo.vincenzi@hsl.org.br.

³Pediatric Intestinal Rehabilitation Center, Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: ckieling@hcpa.edu.br.

⁴Department of Pediatrics, Universidade Federal de São Paulo, Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil. Electronic address: pkochnogueira@gmail.com.

⁵Intestinal Rehabilitation and Transplant Center, Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: roberta.l.longo@gmail.com.

⁶Intestinal Rehabilitation and Transplant Center, Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: nataliacperson@gmail.com.

⁷Intestinal Rehabilitation and Transplant Center, Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: joaoseda@gmail.com.

⁸Intestinal Rehabilitation and Transplant Center, Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: estela.pavanelli@gmail.com.

⁹Intestinal Rehabilitation and Transplant Center, Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: catianagritti@gmail.com.

¹⁰Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil. Electronic address: marijbarcia@gmail.com.

¹¹Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil. Electronic address: fernanda.camargo.hemoped@gmail.com.

¹²Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil. Electronic address: genzani@hotmail.com.

¹³Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil. Electronic address: hatanaka@uol.com.br.

¹⁴Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil. Electronic address: mayumi_uchoa@yahoo.com.br.

¹⁵Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil. Electronic address: simone.perentel@samaritano.com.br.

¹⁶Pediatric Intestinal Rehabilitation Program, Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: mradami@hcpa.edu.br.

¹⁷Pediatric Intestinal Rehabilitation Program, Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: mrceza@hcpa.edu.br.

¹⁸Pediatric Intestinal Rehabilitation Program, Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: dlnunes@hcpa.edu.br.

¹⁹Pediatric Intestinal Rehabilitation Program, Post-Graduate Program of Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil. Electronic address: berelempek@gmail.com.

²⁰Pediatric Intestinal Rehabilitation Program, Pediatric Nursing Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: lgodoy@hcpa.edu.br.

²¹Pediatric Intestinal Rehabilitation Program, Post-Graduate Program of Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: lfeldens@hcpa.edu.br.

²²Pediatric Intestinal Rehabilitation Program, Post-Graduate Program of Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: hgoldani@hcpa.edu.br.

Abstract

Background & aims: To identify predictors of enteral autonomy and survival in pediatric intestinal failure patients followed up at three pediatric intestinal rehabilitation centers from a middle-income country.

Methods: This retrospective multicenter cohort study evaluated patients with intestinal failure from three high-volume intestinal rehabilitation centers on long-term parenteral nutrition between 2014 and 2023. The primary outcome was status at the end of the follow-up: parenteral nutrition dependence, enteral autonomy, transplantation, or death. Secondary outcomes were complications resulting from treatment and current parenteral nutrition dependency index. Competing risk analysis, Cox regression, and a decision tree model were employed.

Results: The cohort comprised 207 patients with a median (interquartile range) age at admission of 6.2 (3.1; 12.9) months and a median follow-up of 29.4 (10.2; 49.6) months. Short bowel (85%) and motility disorders (10.6%) were the primary causes of intestinal failure. Cumulative incidence of 5-year for enteral autonomy and survival rates were 37% and 88%, respectively. Intestinal failure-associated liver disease was present in 24% of patients on admission. Enteral autonomy was associated with remnant intestine length > 40 cm (hazard ratio: 2.0; 95% confidence interval: 1.7; 3.6); age at admission < 6.2 months (hazard ratio: 1.8; 95% confidence interval: 1.0; 3.3); and preserved ileocecal valve (hazard ratio: 3.4; 95% confidence interval: 1.9; 6.0). The overall mortality rate was 7.7%.

Conclusion: The overall survival rate was 92.3% and the 5-year cumulative incidence of enteral autonomy was 37%. The probability of achieving enteral autonomy was associated with early arrival at the intestinal rehabilitation center and favorable bowel anatomy.