Journal of pediatric gastroenterology and nutrition · 2025
Nutritional management and outcomes of malnourished children under 2 years with intestinal failure.
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Pavanelli Estela Cristina, Neto Joao Seda, Farah Beatriz Camilo, Longo Roberta Luiza, Person Natália Canale, Gritti Catiana Mitica, de Jesus Carine Dias Ferreira, de Carvalho Camila Mascarenhas Teixeira, Hayashi Massami, Gameiro Catherina Oliveira, Brufato Jackeline Farias, Blini Gabrielle Marques, Vincenzi Rodrigo
Аннотация
OBJECTIVE: This study aimed to assess the evolution of nutritional status, parenteral nutrition (PN) composition, and PN dependence index (PNDI) in children under 2 years old with intestinal failure (IF) and malnutrition.
METHODS: This retrospective cohort included patients admitted between November 1, 2016, and August 31, 2021, with IF, age ≤24 months, and weight-for-age (Wt/A) <-2 standard deviation with a follow-up of 12 months. Data collected included demographic, anthropometric, biochemical, and nutritional information. The PNDI was compared between enteral autonomy (EA) and nonenteral autonomy (non-EA) groups.
RESULTS: Thirty patients (16 males, 53.33%) were included, and short bowel syndrome (SBS) was the leading cause of IF (n = 27, 90%). The mean age at admission was 7.23 ± 3.90 months, and 36.66% of the patients had a conjugated bilirubin (CB) level >2 mg/dL; 87% had a Wt/A z-score <-3 and 90% had a height-for-age (Ht/A) z-score <-3. At 5 months, the mean Wt/A z-score improved to -1.82. At admission, median protein, lipid, and glucose intake on PN were 3, 1.6, and 17.27 g/kg/day, respectively. In the PNDI analysis, the EA group had a mean index of 141% versus 158% for the non-EA group at admission, with no statistical differences. From the sixth month onward, the EA group showed a significantly lower PNDI (50% vs. 108% for non-EA patients; p = 0.032). Both groups demonstrated adequate nutritional recovery.
CONCLUSION: Adequate multidisciplinary care can reverse severe malnutrition, and the PNDI may be a predictor of EA.
METHODS: This retrospective cohort included patients admitted between November 1, 2016, and August 31, 2021, with IF, age ≤24 months, and weight-for-age (Wt/A) <-2 standard deviation with a follow-up of 12 months. Data collected included demographic, anthropometric, biochemical, and nutritional information. The PNDI was compared between enteral autonomy (EA) and nonenteral autonomy (non-EA) groups.
RESULTS: Thirty patients (16 males, 53.33%) were included, and short bowel syndrome (SBS) was the leading cause of IF (n = 27, 90%). The mean age at admission was 7.23 ± 3.90 months, and 36.66% of the patients had a conjugated bilirubin (CB) level >2 mg/dL; 87% had a Wt/A z-score <-3 and 90% had a height-for-age (Ht/A) z-score <-3. At 5 months, the mean Wt/A z-score improved to -1.82. At admission, median protein, lipid, and glucose intake on PN were 3, 1.6, and 17.27 g/kg/day, respectively. In the PNDI analysis, the EA group had a mean index of 141% versus 158% for the non-EA group at admission, with no statistical differences. From the sixth month onward, the EA group showed a significantly lower PNDI (50% vs. 108% for non-EA patients; p = 0.032). Both groups demonstrated adequate nutritional recovery.
CONCLUSION: Adequate multidisciplinary care can reverse severe malnutrition, and the PNDI may be a predictor of EA.