A retrospective review of the 5-year nutritional and clinical outcomes in pediatric patients undergoing intestinal rehabilitation.

BACKGROUND: The mainstay of modern medical therapy for intestinal failure (IF) is parenteral nutrition (PN). The Intestinal Rehabilitation Program (IRP) goal is enhancing nutritional outcomes for patients receiving total parenteral nutrition (TPN), optimizing/transitioning patients from TPN to enteral nutrition (EN), achieving enteral autonomy, monitoring growth and development. The objective of this study is to describe nutritional and clinical outcomes for children undergoing intestinal rehabilitation during 5 years of the program. METHODS: Retrospective chart review for children from birth to <18 years old with IF who were on TPN from July 2015 to Dec 2020 or to the endpoint of the study when they either weaned from TPN during the 5 year period or continued TPN by Dec 2020 and participated at our IRP. RESULTS: The mean age of the cohort was 2.4 years (±4.22), 53% male. The 3 most common diagnosis were necrotizing enterocolitis (28%), gastroschisis (14%) and intestinal atresia (14%). Nutritional data including days/hours per week on TPN, glucose infusion rate, amino acids, total EN calories, % of total nutrition received from TPN and EN per day all showed statistically significant differences. Our program showed 0% intestinal failure associated liver disease (IFALD), 0% mortality, 100% survival, 41% patients were weaned from TPN (13/32) with mean of 39 months (±32). CONCLUSION: Early referral to a center that can offer IRP, such as ours can lead to tremendous positive clinical outcomes and help patients with intestinal failure avoid transplant as shown in our study.

The Association between Race and Survival among Pediatric Patients with Neuroblastoma in the US between 1973 and 2015.

Background: Conclusive information regarding the influence of race on survival among neuroblastoma patients is limited. Our objective is to investigate the association between race and cause-specific survival in pediatric patients diagnosed with neuroblastoma in the US between 1973 and 2015. Methods: This was a retrospective cohort study using the Surveillance, Epidemiology, and End Result (SEER) database. Patients aged 17 and younger of black, white, or Asian Pacific Islander (API) race diagnosed with neuroblastoma from 1973-2015 were included (n = 2,119). The outcome variable was time from diagnosis to death. Covariates included age, gender, ethnicity, stage, tumor site, and year of diagnosis. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals. Results: There were no statistically significant differences in the hazard of survival for blacks (HR 0.93; 95% confidence interval (CI) 0.74-1.16) or API (HR 1.02; 95% CI 0.76-1.37) compared with whites. However, patients diagnosed between 2000-2004 (HR 0.46; 95% CI 0.36-0.59) and 2005-2015 (HR 0.33; 95% CI 0.26-0.41) had decreased hazards of death when compared to patients treated during 1973 to 1999. Conclusions: No association between race and survival time was found. However, survival improved among all patients treated during 2000-2004 and 2005-2015 compared with those treated before the year 2000, leading to a narrowing of the racial disparity based on survival.