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Article Dans Une Revue Alimentary Pharmacology and Therapeutics Année : 2010

Systematic Review: Medical and Nutritional Interventions for the Management of Intestinal Failure and its Resultant Complications in Children

Résumé

Background and Aims: Intestinal failure (IF) affects a growing number of children due to increasing numbers of preterm infants surviving intestinal resection for necrotising enterocolitis (NEC) and improving surgical techniques for congenital gut anomalies. Parenteral nutrition (PN) is the mainstay of therapy; enteral nutrition (EN) may have trophic effects on the gut. We aimed to systematically review evidence for the effectiveness of medical and nutritional interventions in the treatment of IF in children. Methods: Retrieval of data from studies of patients aged <18yrs and receiving >28 days PN. Outcome measures: improvement in intestinal function; intestinal adaptation; growth; prevention and treatment of IF-associated liver disease; mortality. Cochrane Database (November 2009), Medline (1950-November 2009) and CINAHL (1982-November 2009) electronic database searches were made using keyword and subject headings (MeSH); IF; Short Bowel Syndrome (SBS); PN and Child. The level of the evidence (EL) was assessed using Scottish Intercollegiate Guidelines Network (SIGN) methodology (www.sign.ac.uk). Results: From 1607620 hits, 720 abstracts were reviewed. 33 original papers were included. No studies were of high methodological quality. Conclusions: The evidence base for medical and nutritional interventions in paediatric IF is limited and of poor quality. In the absence of RCTs, this evidence base can improve through case control and cohort research, and with better multi-agency communication the study of inter-centre differences is possible. Achievable short-term goals would include the study of; optimal ursodeoxycholic usage; novel intralipid formulations; cycled enteral antibiotics; enteral probiotics and new enteral feeding strategies.

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hal-00599514 , version 1 (10-06-2011)

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Andrew Barclay, Lynne M Beattie, L T Weaver, David C Wilson. Systematic Review: Medical and Nutritional Interventions for the Management of Intestinal Failure and its Resultant Complications in Children. Alimentary Pharmacology and Therapeutics, 2010, 33 (2), pp.175. ⟨10.1111/j.1365-2036.2010.04514.x⟩. ⟨hal-00599514⟩

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