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Clinical outcome in patients from a single region dependent on parenteral nutrition for 28 days or more
  1. Jutta Köglmeier (jkoeg{at}doctors.org.uk)
  1. Chelsea and Westminster Hospital London, United Kingdom
    1. Christopher Day (chris.day{at}bradfordhospitals.nhs.uk)
    1. Bradford Royal Infirmary, United Kingdom
      1. John Puntis (john.puntis{at}leedsth.nhs.uk)
      1. The General Infirmary at Leeds, United Kingdom

        Abstract

        Background: The frequency and outcome of intestinal failure (IF) in children are not well defined in the UK. Long term parenteral nutrition (PN) is an effective intervention, with intestinal transplantation offering the possibility of survival should life threatening complications arise in those with long term dependency. The ideal model for service provision is the subject of debate.

        Aims: We aimed to identify all new cases of IF (defined as PN dependency ¡Ý 28 days) in West Yorkshire over a two year period, to determine the rate of serious complications, establish the outcome at two year follow up, and clarify the role of specialist referral.

        Method: Pharmacists in all West Yorkshire paediatric units were contacted to establish numbers of children with IF during 2001-2002. Underlying diagnosis, complications, and outcome at two years were obtained by case note review in 93 of the 96 children identified.

        Results: IF patients were exclusively managed in one or other of the three large teaching hospitals. At two year follow-up six (6.4 %) children had died (one while listed for small bowel transplantation), but 85 (91 %) had established full enteral feeding and were well. Two remained PN dependant and were assessed in the supra-regional intestinal transplantation unit (Birmingham); in neither case was small bowel transplantation thought to be appropriate. The most common complications were central venous catheter sepsis (69 % of patients) and cholestasis (59 %).

        Conclusions: This study shows that a favourable outcome for IF can be achieved in a regional centre with appropriate multidisciplinary support. A single UK supra-regional unit undertaking small bowel transplantation is probably adequate for assessment of the most complex patients, although this should remain under review.

        • intestinal failure
        • intestinal transplantation
        • long term parenteral nutrition

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