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Intestinal failure in children

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https://www.readbyqxmd.com/read/28209419/a-safety-and-pharmacokinetic-dosing-study-of-glucagon-like-peptide-2-in-infants-with-intestinal-failure
#1
David L Sigalet, Mary E Brindle, Dana Boctor, Bryan Dicken, Viona Lam, Lily Sia Lu, Elaine de Heuvel, Bolette Hartmann, Jens J Holst
BACKGROUND & AIMS: Glucagon-like peptide 2 (GLP-2) analogues are approved for adults with intestinal failure (IF), but no studies have included infants. This study examined the pharmacokinetics (PK), safety, and nutritional effects of GLP-2 in infants with IF. METHODS: With parental consent (Health Canada Protocol:150,979), parenteral nutrition (PN)-dependent infants were treated with 5-20-μg/kg/day GLP-2 for 3days (phase 1), and if tolerated continued for 42days (phase 2)...
January 29, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28194723/teduglutide-a-review-in-short-bowel-syndrome
#2
Esther S Kim, Susan J Keam
Subcutaneous teduglutide (Revestive(®)), a glucagon-like peptide-2 analogue that increases intestinal absorption, is approved in the EU for the treatment of short bowel syndrome (SBS) in patients aged ≥1 year who are stable following a period of postsurgical intestinal adaptation. In a phase III trial in adults with SBS intestinal failure (IF) dependent on parenteral support (PS), a significantly greater proportion of teduglutide 0.05 mg/kg/day than placebo recipients achieved a ≥20% reduction in weekly PS volume from baseline to week 20 and maintained it to week 24...
February 14, 2017: Drugs
https://www.readbyqxmd.com/read/28190552/use-of-balloon-dilatation-for-management-of-postoperative-intestinal-strictures-in-children-with-short-bowel-syndrome
#3
Christina Belza, Kevin Fitzgerald, Joao Amaral, Karen Steinberg, Yaron Avitzur, Paul W Wales
PURPOSE: Children with short bowel syndrome (SBS) often require numerous operations to optimize intestinal function. Postoperative intestinal strictures are a complication that inhibits enteral feeding advancement and prolongs parenteral nutrition dependency, often requiring reoperation. Our objective was to review our experience with fluoroscopic balloon dilatation to treat intestinal strictures. METHODS: A retrospective cohort study of intestinal failure patients with SBS was completed...
January 30, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28180937/guidelines-for-the-management-of-postoperative-obstructive-symptoms-in-children-with-hirschsprung-disease
#4
REVIEW
J C Langer, M D Rollins, M Levitt, A Gosain, L de la Torre, R P Kapur, R A Cowles, J Horton, D H Rothstein, A M Goldstein
Although most children with Hirschsprung disease ultimately do well, many experience a variety of ongoing problems after pull-through surgery. The most common include obstructive symptoms, soiling, enterocolitis and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative obstructive symptoms in children with Hirschsprung disease. The American Pediatric Surgical Association Board of Governors established a Hirschsprung Disease Interest Group. Group discussions, literature review and expert consensus were then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with obstructive symptoms following pull-through for Hirschsprung disease...
February 8, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28168988/a-comparison-of-broviac-%C3%A2-and-peripherally-inserted-central-catheters-in-children-with-intestinal-failure
#5
Carolina Blotte, Jennifer Styers, Hong Zhu, Nandini Channabasappa, Hannah G Piper
PURPOSE: Central venous catheters (CVCs) are a source of morbidity for children with intestinal failure (IF). Complications include infection, breakage, occlusion, and venous thrombosis. Broviacs® have traditionally been preferred, but peripherally inserted central catheters (PICCs) are gaining popularity. This study compares complications between Broviacs® and PICCs in children with IF. METHODS: After IRB approval, children with IF receiving parenteral nutrition (2012-2016) were reviewed...
January 29, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28149511/the-development-and-role-of-microbial-host-interactions-in-gut-mucosal-immune-development
#6
REVIEW
C R Stokes
At birth the piglet's immune system is immature and it is dependent upon passive maternal protection until weaning. The piglet's mucosal immune system develops over the first few weeks but has not reached maturity at weaning ages which are common on commercial farms. At weaning piglets are presented with a vast and diverse range of microbial and dietary/environmental antigens. Their ability to distinguish between antigens and mount a protective response to potential pathogens and to develop tolerance to dietary antigens is critical to their survival and failure to do so is reflected in the high incidence of morbidity and mortality in the post-weaning period...
2017: Journal of Animal Science and Biotechnology
https://www.readbyqxmd.com/read/28122695/environmental-enteric-dysfunction-is-associated-with-carnitine-deficiency-and-altered-fatty-acid-oxidation
#7
Richard D Semba, Indi Trehan, Ximin Li, Ruin Moaddel, M Isabel Ordiz, Kenneth M Maleta, Klaus Kraemer, Michelle Shardell, Luigi Ferrucci, Mark Manary
BACKGROUND: Environmental enteric dysfunction (EED), a condition characterized by small intestine inflammation and abnormal gut permeability, is widespread in children in developing countries and a major cause of growth failure. The pathophysiology of EED remains poorly understood. METHODS: We measured serum metabolites using liquid chromatography-tandem mass spectrometry in 400 children, aged 12-59months, from rural Malawi. Gut permeability was assessed by the dual-sugar absorption test...
January 18, 2017: EBioMedicine
https://www.readbyqxmd.com/read/28099382/failure-of-nonoperative-management-of-pediatric-blunt-liver-and-spleen-injuries-a-prospective-atomac-study
#8
Maria E Linnaus, Crystal S Langlais, Nilda M Garcia, Adam C Alder, James W Eubanks, R Todd Maxson, Robert W Letton, Todd A Ponsky, Shawn D St Peter, Charles Leys, Amina Bhatia, Daniel J Ostlie, David W Tuggle, Karla A Lawson, Alexander R Raines, David M Notrica
BACKGROUND: Nonoperative management (NOM) is standard of care for most pediatric blunt liver and spleen injuries (BLSI); only 5% of patients fail NOM in retrospective reports. No prospective studies examine failure of NOM of BLSI in children. The aim of this study was to determine the frequency and clinical characteristics of failure of NOM in pediatric BLSI patients. METHODS: A prospective observational study was conducted on patients ≤18 years presenting to any of ten level 1 pediatric trauma centers April 2013 and January 2016 with BLSI on computed tomography...
January 17, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28052886/intestinal-rehabilitation-for-children-with-intestinal-failure-is-cost-effective-a-simulation-study
#9
Henk Groen, Esther G Neelis, Marten J Poley, Joanne F Olieman, René Scheenstra, Paul Fm Krabbe, Gerard Dijkstra, Edmond Hhm Rings
BACKGROUND: Children with intestinal failure (IF) depend on parenteral nutrition (PN). The goal in the treatment of IF is to wean children off PN through intestinal rehabilitation (IR). Although the healthcare burden of IF is enormous, to our knowledge there has been no previous cost-effectiveness analysis in pediatric IF including IR. OBJECTIVE: We sought to determine the cost-effectiveness of IR in terms of costs and life-years. DESIGN: We simulated the treatment of IF in children in a discrete-event model...
January 4, 2017: American Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28052602/optn-srtr-2015-annual-data-report-intestine
#10
J M Smith, M A Skeans, S P Horslen, E B Edwards, A M Harper, J J Snyder, A K Israni, B L Kasiske
Intestine and intestine-liver transplant remains important in the treatment of intestinal failure, despite decreased morbidity associated with parenteral nutrition. In 2015, 196 new patients were added to the intestine transplant waiting list, with equal numbers waiting for intestine and intestine-liver transplant. Among prevalent patients on the list at the end of 2015, 63.3% were waiting for an intestine transplant and 36.7% were waiting for an intestine-liver transplant. The pretransplant mortality rate decreased dramatically over time for all age groups...
January 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28052307/ultrashort-bowel-syndrome-outcome-in-children-treated-in-a-multidisciplinary-intestinal-rehabilitation-unit
#11
Mariela Dore, Paloma Triana Junco, Ane Andres Moreno, Vanesa Nuñez Cerezo, Martha Romo Muñoz, Alba Sánchez Galán, Alejandra Vilanova Sánchez, Gerardo Prieto, Esther Ramos, Francisco Hernandez, Leopoldo Martínez Martínez, Manuel Lopez Santamaria
Aim Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in the pediatric population. Our aim was to review long-term outcome of ultrashort bowel syndrome (USBS) in an Intestinal Rehabilitation Unit (IRU). Patients and Methods Retrospective study of patients with USBS (defined as < 10 cm of remnant small bowel) treated between 2000 and 2015. Demographic data, clinical, and treatment variables including parenteral nutrition (PN), surgical techniques, and intestinal transplantation (IT) were analyzed...
February 2017: European Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27997531/redefining-short-bowel-syndrome-in-the-21st-century
#12
REVIEW
Valeria C Cohran, Joshua D Prozialeck, Conrad R Cole
In 1968, Wilmore and Dudrick reported an infant sustained by parenteral nutrition (PN) providing a potential for survival for children with significant intestinal resections. Increasing usage of TPN over time led to some patients developing Intestinal Failure Associated Liver Disease (IFALD), a leading cause of death and indication for liver/intestinal transplant. Over time, multi-disciplinary teams called Intestinal Rehabilitation Programs (IRPs) began providing meticulous and innovative management. Usage of alternative lipid emulsions and lipid minimization strategies have resulted in the decline of IFALD and an increase in long-term and transplant-free survival, even in the setting of ultrashort bowel (< 20 cm)...
December 20, 2016: Pediatric Research
https://www.readbyqxmd.com/read/27979360/risk-of-post-procedural-bleeding-in-children-on-intravenous-fish-oil
#13
Prathima Nandivada, Lorenzo Anez-Bustillos, Alison A O'Loughlin, Paul D Mitchell, Meredith A Baker, Duy T Dao, Gillian L Fell, Alexis K Potemkin, Kathleen M Gura, Ellis J Neufeld, Mark Puder
BACKGROUND: Intestinal failure-associated liver disease (IFALD) can be treated with parenteral fish oil (FO) monotherapy, but practitioners have raised concerns about a potential bleeding risk. This study aims to describe the incidence of clinically significant post-procedural bleeding (CSPPB) in children receiving FO monotherapy. METHODS: A retrospective chart review was performed on patients at our institution treated with intravenous FO for IFALD. CSPPB was defined as bleeding leading to re-operation, transfer to the intensive care unit, re-admission, or death, up to one month after any invasive procedure...
December 1, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27940670/environmental-enteric-dysfunction-and-growth-failure-stunting-in-global-child-health
#14
REVIEW
Victor Owino, Tahmeed Ahmed, Michael Freemark, Paul Kelly, Alexander Loy, Mark Manary, Cornelia Loechl
Approximately 25% of the world's children aged <5 years have stunted growth, which is associated with increased mortality, cognitive dysfunction, and loss of productivity. Reducing by 40% the number of stunted children is a global target for 2030. The pathogenesis of stunting is poorly understood. Prenatal and postnatal nutritional deficits and enteric and systemic infections clearly contribute, but recent findings implicate a central role for environmental enteric dysfunction (EED), a generalized disturbance of small intestinal structure and function found at a high prevalence in children living under unsanitary conditions...
December 2016: Pediatrics
https://www.readbyqxmd.com/read/27857647/nutrition-chez-le-br%C3%A3-l%C3%A3
#15
G Perro
Nutrition is a challenge for burn patients. Emphasized points are early enteral amounts by means of a naso-gastric tube, semi-recumbent position > 30°, gastro-intestinal survey improved by kinetics, weight evolution, nutritional amounts assessment to prevent proteino-energetic deficiency. Feeding is difficult with children, as with seniors often associating a preexisting starvation. Nutritional supplements are useful in medium severity patients. For overweight patients, hypo caloric and hyperprotidic diet is the better choice...
March 31, 2016: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/27855998/outcomes-from-a-12-week-open-label-multicenter-clinical-trial-of-teduglutide-in-pediatric-short-bowel-syndrome
#16
Beth A Carter, Valeria C Cohran, Conrad R Cole, Mark R Corkins, Reed A Dimmitt, Christopher Duggan, Susan Hill, Simon Horslen, Joel D Lim, David F Mercer, Russell J Merritt, Peter F Nichol, Luther Sigurdsson, Daniel H Teitelbaum, John Thompson, Charles Vanderpool, Juliana F Vaughan, Benjamin Li, Nader N Youssef, Robert S Venick, Samuel A Kocoshis
OBJECTIVE: To determine safety and pharmacodynamics/efficacy of teduglutide in children with intestinal failure associated with short bowel syndrome (SBS-IF). STUDY DESIGN: This 12-week, open-label study enrolled patients aged 1-17 years with SBS-IF who required parenteral nutrition (PN) and showed minimal or no advance in enteral nutrition (EN) feeds. Patients enrolled sequentially into 3 teduglutide cohorts (0.0125 mg/kg/d [n = 8], 0.025 mg/kg/d [n = 14], 0...
February 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/27849236/treatment-of-short-bowel-syndrome-in-children-value-of-the-intestinal-rehabilitation-program
#17
Uenis Tannuri, Fabio de Barros, Ana Cristina Aoun Tannuri
The main cause of acute intestinal failure is short bowel syndrome, generally as a result of resection of extensive segments of small intestine. As a result, the main symptoms are watery diarrhea, malabsorption syndrome, chronic malnutrition, and death, if the patient is not properly treated. If the length of the remaining intestine is greater than 30 cm, complete adaptation is possible and the patient may not require parenteral nutrition. The currently recommended treatment includes the use of prolonged parenteral nutrition and enteral nutrition, always aimed at constant weight gain, in conjunction with surgeries aimed at elongating the dilated bowel...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27836825/intestinal-failure-in-children-and-young-people-with-neurodisabling-conditions
#18
REVIEW
Amar M Wahid, Colin V Powell, Ieuan H Davies, Jennifer A Evans, Huw R Jenkins
Gastrointestinal dysmotility is common in children and young people with neurodisabling conditions. In this article we seek to highlight the increasing difficulties faced by paediatricians in managing intestinal failure in this patient group. It is becoming clear that, as the median age for survival increases, intestinal failure is a significant problem, and can in some cases become life-limiting. The ethical issues around starting children with life-limiting conditions on parenteral nutrition (PN) are extremely complicated, not least because we are ignorant of the mechanism of intestinal failure in these children, and indeed, which of these children might be able to return to enteral feeding after a period of PN...
November 11, 2016: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/27784959/endocrine-manifestations-in-celiac-disease
#19
REVIEW
Hugh James Freeman
Celiac disease (CD) is an autoimmune small intestinal mucosal disorder that often presents with diarrhea, malabsorption and weight loss. Often, one or more associated endocrine disorders may be associated with CD. For this review, methods involved an extensive review of published English-language materials. In children and adolescents, prospective studies have demonstrated a significant relationship to insulin-dependent or type 1 diabetes, whereas in adults, autoimmune forms of thyroid disease, particularly hypothyroidism, may commonly co-exist...
October 14, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/27782890/pediatric-small-bowel-transplantation-a-single-center-experience-from-turkey
#20
Cem Tuğmen, Maşallah Baran, İsmail Sert, Ayşe Berna Anıl, Eyüp Kebapçı, Sait Murat Doğan, Selçuk Kılınç, Gaye Aydın, Ayşe Gülden Diniz, Mustafa Ölmez, İbrahim Pirim, Cezmi Karaca
BACKGROUND/AIMS: Small bowel transplantation (SBTx) is a treatment option for patients with serious parenteral nutrition-related problems in intestinal failure. İzmir Tepecik Training Research Hospital Organ Transplantation Center is still the only pediatric intestinal transplant center in Turkey. MATERIAL AND METHODS: This study was approved by the local ethics committee. Patients' data were analyzed from the medical charts and the hospital digital database. Seven isolated SBTxs were performed in six children between 2010 and 2016...
September 2016: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
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