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Abstract：
To assess the effectiveness of postoperative feeding guidelines in reducing the incidence and severity of intestinal failure-associated liver disease (IFALD) among infants.
Two cohorts of infants <6 months old undergoing intestinal surgery were compared: preguideline (retrospective data from 2007 to 2013; n = 83) and postguideline (prospective data from 2013 to 2016; n = 81). The guidelines included greater initial enteral nutrition volumes of 20 mL/kg/d and daily feeding advancement if tolerated. The primary outcomes were incidence of IFALD (peak direct bilirubin [DB] >2 mg/dL) and severity (DB >5 mg/dL for moderate-severe). Multiple logistic regression was used to determine the odds of developing IFALD. Other outcomes were time to reach 50% and 100% goal calories from enteral nutrition and the incidence of necrotizing enterocolitis after feeding.
The incidence of IFALD decreased from 71% to 51% (P = .031), and median peak DB decreased from 5.7 to 2.4 mg/dL (P = .001). After adjusting for diagnosis and prematurity, the odds of developing IFALD of any severity were reduced by 60% (OR 0.40, 95% CI 0.20-0.85), and the odds of developing moderate-to-severe IFALD were reduced by 72% (OR 0.28, 95% CI 0.13-0.58) with guideline use. Time to reach 50% enteral nutrition decreased from a median of 10 to 6 days (P = .020) and time to reach 100% enteral nutrition decreased from 35 to 21 days (P = .035) with guideline use. The incidence of necrotizing enterocolitis after initiating enteral nutrition did not change (5% vs 9%, P = .346).
Implementation of feeding guidelines reduced time to reach feeding goals, significantly reducing IFALD incidence and severity.
Two cohorts of infants <6 months old undergoing intestinal surgery were compared: preguideline (retrospective data from 2007 to 2013; n = 83) and postguideline (prospective data from 2013 to 2016; n = 81). The guidelines included greater initial enteral nutrition volumes of 20 mL/kg/d and daily feeding advancement if tolerated. The primary outcomes were incidence of IFALD (peak direct bilirubin [DB] >2 mg/dL) and severity (DB >5 mg/dL for moderate-severe). Multiple logistic regression was used to determine the odds of developing IFALD. Other outcomes were time to reach 50% and 100% goal calories from enteral nutrition and the incidence of necrotizing enterocolitis after feeding.
The incidence of IFALD decreased from 71% to 51% (P = .031), and median peak DB decreased from 5.7 to 2.4 mg/dL (P = .001). After adjusting for diagnosis and prematurity, the odds of developing IFALD of any severity were reduced by 60% (OR 0.40, 95% CI 0.20-0.85), and the odds of developing moderate-to-severe IFALD were reduced by 72% (OR 0.28, 95% CI 0.13-0.58) with guideline use. Time to reach 50% enteral nutrition decreased from a median of 10 to 6 days (P = .020) and time to reach 100% enteral nutrition decreased from 35 to 21 days (P = .035) with guideline use. The incidence of necrotizing enterocolitis after initiating enteral nutrition did not change (5% vs 9%, P = .346).
Implementation of feeding guidelines reduced time to reach feeding goals, significantly reducing IFALD incidence and severity.
摘要：
评估术后喂养指南在降低婴幼儿肠衰竭相关性肝病（IFALD）发生率和严重程度方面的有效性。
比较了两组6个月以下接受肠道手术的婴儿：指南前（2007年至2013年的回顾性数据；n=83）和指南后（2013年至2016年的前瞻性数据；n=81）。指南包括更大的初始肠内营养量20mL/kg/d和每日喂养提前如果耐受。主要结果是IFALD的发生率（峰值直接胆红素[DB]>2mg/dL）和严重程度（中度-重度DB>5mg/dL）。使用多元逻辑回归来确定发生IFALD的几率。其他结果是肠内营养达到50％和100％目标卡路里的时间以及喂养后坏死性小肠结肠炎的发生率。
IFALD的发生率从71％下降到51％（P=0.031），中位数峰值DB从5.7下降到2.4mg/dL（P=0.001）。在调整诊断和早产后，发生任何严重程度的IFALD的几率降低了60%(OR0.40，95%CI0.20-0.85)，指南使用后,发生中重度IFALD的几率降低了72%(OR0.28,95%CI0.13-0.58).使用指南，达到50％肠内营养的时间从中位数10天减少到6天（P=0.020），达到100％肠内营养的时间从35天减少到21天（P=0.035）。开始肠内营养后坏死性小肠结肠炎的发生率没有变化（5％vs9％，P=.346）。
实施喂养指南缩短了达到喂养目标的时间，显著降低IFALD发生率和严重程度。
比较了两组6个月以下接受肠道手术的婴儿：指南前（2007年至2013年的回顾性数据；n=83）和指南后（2013年至2016年的前瞻性数据；n=81）。
IFALD的发生率从71％下降到51％（P=0.031），
实施喂养指南缩短了达到喂养目标的时间，
