Lezo Antonella, D'Eusebio Chiara, Riboldi Lorenzo, Baldini Letizia, Spada Marco
Dietetic and Clinical Nutrition Unit, Paediatric Hospital Regina Margherita, University of Turi, Turin, Italy.
Postgraduate School of Paediatrics, University of Turin, Turin, Italy.
Front Nutr. 2022 Jun 9;9:868273. doi: 10.3389/fnut.2022.868273. eCollection 2022.
Chronic intestinal failure (CIF) therapy changed significantly in recent decades, and both survival and complication rates improved over time. International guidelines claim that early referral of long-term home parenteral nutrition (HPN) patients to an expert center with specific standards of care may positively affect long-term outcomes. Herein, we retrospectively analyse the long-term outcomes of a cohort of pediatric patients with CIF followed-up since our Pediatric Intestinal Failure Unit foundation, in 1989.
Data of the 120 children followed up at Pediatric Intestinal Failure Unit during the last 28 years were retrospectively collected. Patients' and HPN characteristics, as well as dependence, survival, and complication rates, were described.
Incidence and prevalence of CIF increased during the study period particularly due to the increase of HPN for non-digestive disease (NDD) CIF (47.5% of the study sample). Catheter-related bloodstream infection (CRBSI) rate decreased over the study period: 0.33 episodes/1,000 catheters days before 2011 and 0.19 episodes/1,000 catheters days afterwards. Only 1 patient out of 12 died because of HPN complications. The survival rate of patients with PDD was 98.4% at 1 year from the beginning of HPN, 96.5% at 2 years, and 93.8% from the fifth year onwards. Concerning the dependence rate, 70.6% of patients were still on HPN 1 year after the start of HPN, 63.7% at 2 years, 52.4% at 5 years, and 40.8% from the 9th year onwards, with no significant difference according to the underlying intestinal pathology. The survival rate of NDD patients was 91.2% at 1 year from the beginning of HPN, 87.4% at 2 years, and 81.9% from the third year onwards. For what concerns the enteral autonomy, it was regained by 56.7% 1 year after the start of HPN, 74.5% at 2 years, and 95.0% in the 5th year.
Our data confirmed the importance of appropriate standards of care and suggest that applying a specific set of standards and protocols may further improve patients' outcomes and survival. Indeed, both primary and non-digestive diseases HPN showed good outcomes.
近几十年来，慢性肠衰竭（CIF）的治疗发生了显著变化，生存率和并发症发生率均随时间有所改善。国际指南称，将长期家庭肠外营养（HPN）患者早期转诊至具备特定护理标准的专家中心可能会对长期预后产生积极影响。在此，我们回顾性分析了自1989年我们的儿科肠衰竭病房成立以来随访的一组儿科CIF患者的长期预后。
回顾性收集了过去28年在儿科肠衰竭病房随访的120名儿童的数据。描述了患者和HPN的特征，以及依赖程度、生存率和并发症发生率。
在研究期间，CIF的发病率和患病率有所增加，特别是由于非消化系统疾病（NDD）所致CIF的HPN使用增加（占研究样本的47.5%）。在研究期间，导管相关血流感染（CRBSI）率有所下降：2011年前为0.33例/1000导管日，之后为0.19例/1000导管日。120名患者中只有1例因HPN并发症死亡。PDD患者从开始HPN起1年的生存率为98.4%，2年时为96.5%，从第5年起为93.8%。关于依赖率，70.6%的患者在开始HPN后1年仍在接受HPN治疗，2年时为63.7%，5年时为52.4%，从第9年起为40.8%，根据潜在肠道病理情况无显著差异。NDD患者从开始HPN起1年的生存率为91.2%，2年时为87.4%，从第3年起为81.9%。关于肠内自主性，在开始HPN后1年有56.7%的患者恢复，2年时为74.5%，第5年时为95.0%。
我们的数据证实了适当护理标准的重要性，并表明应用一套特定的标准和方案可能会进一步改善患者的预后和生存率。事实上，原发性疾病和非消化系统疾病的HPN均显示出良好的预后。
