Introduction: Intestinal failure (IF) is managed with intravenous nutrition (IVN), but the point at which a patient can be classified as having prolonged IF requiring multidisciplinary care, has been variously described as “weeks to months” ⁽¹⁾ to “on IVN for >28 days” ⁽²⁾. The lack of a clear identifier makes it difficult to determine the incidence, compare literature and to apply guidelines.

An audit of five years of inpatient IVN delivery was undertaken at the only tertiary children’s hospital in New Zealand to produce baseline data for the New Zealand National Intestinal Failure Service (NZ NIFS). Intestinal failure, requiring notification to NZ NIFS, has been defined as IVN for ≥21 days, with the aim of optimising patient centered care early in the clinical course.

The aim of this audit was to identify if early or later registration produced similar population characteristics. The involvement of NZ NIFS would focus clinician attention on the impact of IVN treatment; over representation of any one group could use resources unnecessarily.

Method: Patient clinical and IVN records, between 1st July 2010 and 30th June 2015, were retrospectively reviewed to identify gender, age, lead clinical team and clinical outcome. Indications for IVN were those used in the NZ NIFS database, adapted from the ESPEN pathophysiological classifications ⁽³⁾. Intestinal failure was defined as both ≥21 days and ≥28 days to provide two groups for comparison using a Fishers exact test.

Results: Using ≥21 days, 109/572 patients (19%) met the IF definition, 51 (47%) were female, 63 (58%) had a primary digestive disorder, 70 (64%) achieved enteral autonomy.

Using ≥28 days, 78/572 (14%) met the IF definition, 37 (47%) were female, 43 (55%) had a primary digestive disorder, 46 (59%) achieved enteral autonomy.

The ≥21 day criteria identified 28% more patients, but there was no significant difference between the groups for patient demographics, indication, clinical team or outcome.

Discussion: While the ≥21 day criteria identified more IF patients the groups were similar in all other ways.

Recognition of IF early in the clinical course draws attention to the physiological and psychological impact of IVN therapy. Oversight of a group like NZ NIFS encourages intestinal rehabilitation and aims to reduce time on IVN. Standardisation of the clinical definition of IF in the paediatric population would lead to the production of comparable data in a very small, but diverse, population of patients. 

[1] (1) ESPEN endorsed recommendation. Management of acute intestinal failure: A position paper from the(1) European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group. Clinical Nutrition. 2016; 32: 1209-1218.
[2] (2) British Intestinal Failure Survey (BIFS), a registry for long term parenteral nutrition (PN). British Society of Paediatric Gastroenterology Hepatology and Nutrition. www.bspghan.org.uk accessed November 2016.
[3] (3) ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clinical Nutrition. 2105; 34: 171-180.