Intestinal Failure in Childhood

Abstract

Intestinal failure (IF) requires the use of parenteral nutrition (PN) for as long as it persists and in case of irreversible IF may be an indication for intestinal transplantation (ITx). Biological evaluation of IF is becoming possible with the use of plasma citrulline as a marker of intestinal mass. Short bowel syndrome (SBS) is the leading cause of intestinal failure in infants while few epidemiological data are to date available. Data on morbidity and mortality in pediatric patients with SBS are very limited but long-term outcomes seems to be improving. Other causes of intestinal failure include neuro-muscular intestinal disease and congenital disease of enterocyte development. The management of IF should include therapies adapted to each type and stage of IF based on a multidisciplinary approach in centers involving pediatric surgery, pediatric gastroenterology, parenteral nutrition expertise, home- parenteral nutrition program, liver-intestinal transplantation experience. Timing for referral of patients in specialized centers remains a crucial issue.