Neonatal Onset Intestinal Failure: An Italian Multicenter Study

Salvia, Gennaro; Guarino, Alfredo; Terrin, Gianluca; Cascioli, Concetta; Paludetto, Roberto; Indrio, Flavia; Lega, Laura; Fanaro, Silvia; Stronati, Mauro; Corvaglia, Luigi; Tagliabue, Paolo; De Curtis, Mario; Working Group on Neonatal Gastroenterology of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP),

doi:10.1016/j.jpeds.2008.05.017

« Previous Next »The Journal of Pediatrics
Volume 153, Issue 5 , Pages 674-676.e2, November 2008

Neonatal Onset Intestinal Failure: An Italian Multicenter Study

Gennaro Salvia, MD
- NICU “Buon Consiglio” Fatebenefratelli Hospital of Naples, Naples, Italy
- Reprint requests: Gennaro Salvia, MD, Neonatal Intensive Care Unit, “Buon Consiglio Fatebenefratelli Hospital” of Naples, Via A. Manzoni 220, 80123 Naples, Italy
Alfredo Guarino, MD
- Department of Pediatrics, University of Naples “Federico II” Naples, Italy
Gianluca Terrin, MD
- NICU “Buon Consiglio” Fatebenefratelli Hospital of Naples, Naples, Italy
Concetta Cascioli, MD
- Department of Pediatrics, University of Naples “Federico II” Naples, Italy
Roberto Paludetto, MD
- Department of Pediatrics, University of Naples “Federico II” Naples, Italy
Flavia Indrio, MD
- Department of Pediatrics, University of Bari, Bari, Italy
Laura Lega, MD
- NICU Anna Meyer Children's Hospital, Florence, Italy
Silvia Fanaro, MD
- Department of Pediatrics, University of Ferrara, Ferrara, Italy
Mauro Stronati, MD
- San Matteo Hospital, University of Pavia, Pavia, Italy
Luigi Corvaglia, MD
- Department of Pediatrics, University of Bologna, Bologna, Italy
Paolo Tagliabue, MD
- San Gerardo Hospital University of Milano-Bicocca, Monza, Italy
Mario De Curtis, MD
- Department of Gynecological Sciences, Perinatology and Child Health, University of Rome “La Sapienza”, Rome, Italy
Working Group on Neonatal Gastroenterology of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP)

Received 27 February 2008; received in revised form 21 April 2008; accepted 9 May 2008. published online 01 July 2008.

Objective

To describe the natural course of intestinal failure with onset in the neonatal period to provide data regarding the occurrence and to provide a population-based survey regarding the spectrum of underlying diseases.

Study design

We performed a retrospective chart review including infants admitted to the neonatal intensive care unit of 7 Italian tertiary care centers. Intestinal failure was defined as a primary intestinal disease that induces the need of total parenteral nutrition (PN) for more than 4 weeks or the need of partial PN for more than 3 months.

Results

The total number of live births during the study time within the enrolled institutions was 30 353, and the number of newborns admitted to the neonatal intensive care unit was 5088. Twenty-six patients satisfied the definition of intestinal failure; thus the occurrence rate of intestinal failure was 0.1% among live-birth newborns and 0.5% among infants at high risk. The main underlying diseases leading to intestinal failure in neonatal age were congenital intestinal defects (42.3%), necrotizing enterocolitis (30.8%), severe intestinal motility disorder (11.5%), intestinal obstruction (7.7%), structural enterocyte defects (3.8%), and meconium peritonitis (3.8%). After a follow-up of 36 months, 84.6% of patients achieved intestinal competence, 1 patient was still receiving home PN, 1 patient underwent transplantation, and 2 patients died. Cholestatic liver disease was diagnosed in 54% of observed children.

Conclusion

An understanding of the incidence, causes, and natural history of intestinal failure would be helpful to appropriately allocate resources and to plan clinical trials.

Abbreviations: NICU, Neonatal intensive care unit, PN, Parenteral nutrition, SBS, Short bowel syndrome