P4.51: Follow-up of nutritional status and growth in children with intestinal failure receiving long-term parenteral nutrition

Introduction: Regular and frequent monitoring of the patient’s nutritional status is necessary for optimizing nutritional support in children with intestinal failure (IF). We aimed at examining the changes in anthropometric nutritional status and identifying factors associated with this outcome in children with IF followed at a pediatric intestinal rehabilitation center. Methods: Prospective cohort study in 13 children with IF (8 males and 5 females), mean current age of 32.9 (16.7) months. Patients were followed-up at an intestinal rehabilitation center between July 2015 and December 2018; all were receiving long-term parenteral nutrition (PN). The main primary cause of IF was necrotizing enterocolitis (6/13) and 7 patients had ultrashort bowel syndrome. Z scores of weight, height, and body mass index for age were routinely monitored at two-week intervals and compared with the WHO reference standards. Data were collected regarding the energy and protein supplied by PN and by oral/tube feeding route. Age, sex, time of follow-up, prematurity, length of the remnant small bowel, ostomy and the diagnosis of intestinal failure associated liver disease were the main explanatory variables for the outcome (Z scores of weight/age and height/age). The effect of the exposure variables on the outcomes was analyzed by generalized estimating equations. Results: The median time of follow up was 16.5 months, with interquartile range (IQR) of 8.9 to 32.4 months. The Z scores of the anthropometric parameters increased significantly during the follow-up. Median weight/age Z score increased from -3.68 (IQR: -4.97 to -2.66) to 0.45 (IQR: -2.0 to 0.44) and mean height/age Z score increased from -3.93 (IQR: -4.66 to -2.63) to -1.12 (IQR -4.18 to -0.28). Malnutrition (based on weight for age Z score) decreased from 77% to 23% by the last assessment. Mean (SD) total energy and protein supply were 88 (23.4) kcal/kg/day and 2.3 (0.7) g/kg/day, respectively, and both decreased significantly along the follow-up period (p< 0.001). Mean energy and protein supply by PN were 67.6 (SD 17.5) kcal/kg/d and 1.8 (0.5) g/kg/d respectively. The increase in the anthropometric z scores was not associated with any of the clinical and demographic factors considered in the analysis. Conclusion: There was a significant improvement in the nutritional status of children during the follow-up period. This improvement seems to occur independently of demographic factors and comorbidities.