P2.38: Contemporary outcomes of pediatric intestinal failure: a multicenter study
Bibliographic record
Abstract
Introduction:Important changes in the management of pediatric intestinal failure (IF) have been implemented over the last 15 years. Objective:To assess the impact of those changes on the outcome of a contemporary cohort of pediatric IF patients from 6 IF programs, 5 of which offer intestinal transplantation. Methods:Retrospective analysis of a multicenter IF cohort. Entry criteria included patients < 18 years of age receiving PN for more than 42 consecutive days, primary gastroenterological disorder and diagnosis of IF between 2010 and 2015. Primary outcome was death, transplant or enteral autonomy. Kaplan-Meier analysis was used for time-to-event and competing risk analysis for cumulative incidence rates. Comparisons were conducted with a log rank test and Cox regression analysis. Results:443 patients (male 61%) with a median gestational age of 34 weeks (29–37) and birth weight of 2.1 kg (1.2–2.8) constituted the study group. Patients were followed for 3.8 years (2.3–5.3). Median time on PN was 384 days (110–947). Patients had 40% (16–100) of expected small bowel length for age remaining and 250 (56.4%) patients had intact full colon in continuity. Main etiologies included necrotizing enterocolitis (29.3%), abdominal wall defects (30.5%), dysmotility disorders (7.2%), and mucosal enteropathies (6.8%). Eighty-one patients (18.3%) developed progressive intestinal failure associated liver disease (IFALD) with a bilirubin >75mmol/l. All patients were managed with hepatoprotective nutritional strategies (fish oil based lipids or lipid lowering strategies). The presence of IFALD impacted negatively on transplant free survival (P<0.001) and achievement of enteral autonomy (P<0.01). Overall, 213 (48.1%) patients achieved enteral autonomy, 137 (30.9%) remained on PN, 53 (12%) were transplanted and 40 (9%) patients died. Achievement of enteral autonomy was associated with short bowel syndrome (P<0.01), NEC (P=0.026), intact colon (P<0.01), and ileocecal valve (P<0.01). Conclusions:This contemporary cohort achieved a significantly lower incidence of death and transplantation compared with previous multicenter reports. However, the number of children achieving enteral autonomy has not changed while a larger number of patients remain PN dependent. Although this cohort may represent a more complex group of patients due to potential referral bias, these findings suggests a shift in outcomes and a need for new strategies for the achievement of enteral autonomy.
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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 | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| 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".