Koehler A N, Yaworski J A, Gardner M, Kocoshis S, Reyes J, Barksdale E M
Department of Pediatric Surgery, Children's Hospital of Pittsburgh, PA 15213, USA.
J Pediatr Surg. 2000 Feb;35(2):380-5. doi: 10.1016/s0022-3468(00)90045-9.
BACKGROUND/PURPOSE: Intestinal failure is a complex metabolic process that results from malabsorption and malnutrition and provides challenges for a variety of pediatric subspecialists. The purpose of this study was to evaluate the effect of coordinated interdisciplinary team management of children with intestinal failure on nutritional outcome measures.
The Intestinal Care Center (ICC) is staffed with an interdisciplinary team of pediatric specialists including a gastroenterologist, pediatric surgeon, transplant surgeon, clinical dietitians, and a nutrition support nurse. Using an established registry, the authors conducted a comprehensive evaluation of patient data including anthropometric measures, organ system function, and mode of nutrition support. Disease-associated complications including micronutrient deficiencies, growth delay, and death also were monitored. Nutritional outcome was assessed by transition from enteral to oral feeding, cessation of total parenteral nutrition (TPN), and maintenance of linear growth.
Since the inception of the ICC in 1996, 103 patients (69 boys, 34 girls) with intestinal failure have been evaluated with a median age of 2.6 years (range, 0.2 to 21.3 years). Mode of nutritional therapy on initial consultation included TPN (n = 76, 74%), enteral feedings (n = 6, 6%) and oral intake (n = 21, 20%). After intensive management of the 76 patients who were TPN dependent, 22 (29%) subsequently have been weaned from TPN (duration, 0.2 to 17.5 years) to oral (n = 14), oral-enteral (n = 4) or enteral feedings (n = 4). Of the 6 patients who were receiving enteral feedings, 4 (67%) were transitioned to oral feedings. Sixty-eight patients (66%) had evidence of hepatic disease. Of these, 10 underwent transplant, and 23 died (2 posttransplant). Linear growth velocity of neither pre- nor postpubescent patients significantly improved during the 2-year study period.
Data registry establishment and concurrent interdisciplinary team management of children with intestinal failure provides for innovative treatment approaches and a foundation for retrospective or prospective assessment of children with disease.
背景/目的：肠衰竭是一种复杂的代谢过程，由吸收不良和营养不良引起，给各类儿科亚专科医生带来了挑战。本研究的目的是评估对肠衰竭患儿进行跨学科团队协作管理对营养结局指标的影响。
肠道护理中心（ICC）配备了一支由儿科专家组成的跨学科团队，包括胃肠病学家、小儿外科医生、移植外科医生、临床营养师和营养支持护士。作者利用已建立的登记系统，对患者数据进行了全面评估，包括人体测量指标、器官系统功能和营养支持方式。还监测了与疾病相关的并发症，包括微量营养素缺乏、生长发育迟缓及死亡情况。通过从肠内喂养过渡到口服喂养、停止全胃肠外营养（TPN）以及维持线性生长来评估营养结局。
自1996年ICC成立以来，共评估了103例肠衰竭患者（69例男孩，34例女孩），中位年龄为2.6岁（范围0.2至21.3岁）。初次会诊时的营养治疗方式包括TPN（n = 76，74%）、肠内喂养（n = 6，6%）和口服摄入（n = 21，20%）。在对76例依赖TPN的患者进行强化管理后，22例（29%）随后成功停用TPN（持续时间0.2至17.5年），改为口服（n = 14）、口服 - 肠内（n = 4）或肠内喂养（n = 4）。在6例接受肠内喂养的患者中，4例（67%）过渡到口服喂养。68例患者（66%）有肝病证据。其中，10例接受了移植，23例死亡（2例移植后死亡）。在为期2年的研究期间，青春期前和青春期后的患者线性生长速度均未显著改善。
建立数据登记系统并对肠衰竭患儿进行同步跨学科团队管理，为创新治疗方法提供了条件，并为回顾性或前瞻性评估患病儿童奠定了基础。
