Cisapride® Use in Pediatric patients with Intestinal Failure and its Impact on Progression of Enteral Nutrition
Bibliographic record
Abstract
Background: Gastrointestinal dysmotility is common in pediatric intestinal failure patients (PIF), leading to delays in advancement of enteral nutrition (EN) and inability to wean parenteral nutrition (PN). Data on the safety and efficacy of Cisapride® for this purpose is scarce. Objectives: Describe a single center experience with Cisapride® and its impact on enteral nutrition progression in patients with IF. Study design: Retrospective cohort study of PIF patients managed in a multidisciplinary intestinal rehabilitation program between January 2008 - December 2015. Percentage of EN prior to initiation of Cisapride® (proportion of overall kcal/kg being delivered enterally), progression of EN percentage at 3 and 6 months and ability to wean PN were calculated. Rate of progression per day in the 3 months pre and post Cisapride were also evaluated. Side effects were recorded to characterize safety of Cisapride® use. Results: There was no statistical difference in patient demographics or anatomy between patients who were treated with Cisapride versus other prokinetics. Use of any prokinetic was identified in 61/106 patients (57.5%), 29/61 patients (47.5%) failed to advance EN on other prokinetics and started on Cisapride®. Before initiation of Cisapride® the progression of EN had plateaued for a mean of 42.3±60.2 days. The rate of advancement of EN volume progression rate pre Cisapride® was 0.14%/day±0.19%/day and after Cisapride® initiation improved significantly to 0.69%/day±0.31%/day (p < 0.001). Percentage of EN tolerance 3 months after initiation of Cisapride® significantly improved compared to baseline (23.9% vs 79.4 % respectively; p < 0.001). Cisapride® was discontinued in 2/29 (6.8%) patients (1 for prolonged QTc and 1 as a precaution due to cardiomegaly secondary to selenium deficiency). Conclusion: Cisapride® can be beneficial in PIF patients who have failed to progress EN after using other first line prokinetics. The most significant period of improved EN intake occurred within 3 months of Cisapride® initiation. Cardiac side effects in our cohort were lower than previously reported, however cardiac monitoring is still recommended.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".