The impact of multi-disciplinary intestinal rehabilitation programs on the outcome of pediatric patients with intestinal failure: A systematic review and meta-analysis

Background: Pediatric intestinal failure (IF) is a complex clinical problem requiring coordinated multi-disciplinary care. Our objective was to review the evidence for the benefit of intestinal rehabilitation programs (IRP) in pediatric IF patients. Methods: A systematic review was performed on Medline (1950-2012), Pubmed (1966-2012), and Embase (1980-2012) conference proceedings and trial registries. The terms short bowel syndrome, intestinal rehabilitation, intestinal failure, patient care teams, and multi-disciplinary teams were used. Fifteen independent studies were included. Three studies that were cohort studies, including a comparison group, were included in a meta-analysis. Results: Compared to historical controls (n = 103), implementation of an IRP (n = 130) resulted in a reduction in septic episodes (0.3 vs. 0.5 event/month; p = 0.01) and an increase in overall patient survival (22% to 42%). Non-significant improvements were seen in weaning from PN (RR = 1.05, 0.88-1.25, p = 0.62), incidence of IFALD (RR = 0.2, 0-17.25, p = 0.48), and relative risk of liver transplantation (3.99, 0.75-21.3, p = 0.11). Other outcomes reported included a reduction in calories from parenteral nutrition (100% to 32%-56%), earlier surgical/transplant evaluation, and improved coordination of patient care. Conclusion: For pediatric IF patients, IRPs are associated with reduced morbidity and mortality. Standardized clinical practice guidelines are necessary to provide uniform patient care and outcome assessment. (C) 2013 Elsevier Inc. All rights reserved.