Official Sections CTRMS ISVCA IPITA IPTA ISODP IRTA IXA SPLIT TID

2013 - ISBTS 2013 Symposium


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Mini-Oral Communications 1

12.245 - Multiple micronutrient deficiencies among intestinal failure patients during and after transition to enteral nutrition

Presenter: Conrad, Cole, , United States
Authors: Agozie Ubesie1, Samuel Kocoshis1, Adam Mezoff1, Carol Anderson1, Michael Helmrath1, Conrad Cole1

Multiple micronutrient deficiencies among intestinal failure patients during and after transition to enteral nutrition

Agozie Ubesie1, Samuel Kocoshis1, Adam Mezoff1, Carol Anderson1, Michael Helmrath1, Conrad Cole1

1Intestinal Rehabilation Program, Intestinal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background:Micronutrient malabsorption occurs in intestinal failure (IF) due to anatomic defects, physiologic derangements or a combination of both. Micronutrient deficiencies are associated with an increased risk for morbidity and mortality.
Objective:To determine the prevalence of specific micronutrient (iron, zinc, magnesium, phosphorus, selenium, copper, folate, vitamins A, D E and B12) deficiencies in children with IF, and identify risk factors associated with developing these deficiencies.
Method:A retrospective review of prospectively collected data from children with IF managed by the intestinal rehabilitation program at Cincinnati Children’s Hospital Medical Center, Ohio, USA between July 31st 2007 and August 1st 2012. Transition to full enteral nutrition was defined as the period during which the patient received between 20%-100% of estimated required nutrition enterally. Full enteral nutrition (FEN) was defined as the patient tolerating all of the estimated required nutrition (100%) enterally for > 2 weeks.
Results:One hundred and seventy eight IF patients were included in the study. Necrotizing enterocolitis (NEC) was the most common cause of IF (27.5 %). Weight percentiles were statistically greater within the cohort of patients on FEN than those in transition(P=0.004). Iron was the most common micronutrient deficiency identified during (83.9%) and after (61%) successful transition to FEN although significant reduction in the percentage of patients with iron deficiency occurred between the two periods (P=0.003). The majority (92.8%) of the subjects were anemic during transition to FEN but only 43.2% while on FEN (P<0.001). Univariate analysis showed that significant predictors of micronutrient deficiency after successful transition to FEN include birth weight (P=0.03), weight percentiles (P=0.02), height percentiles (P=0.04) and PN duration (P=0.013).  After multivariate adjustments, only PN duration remained statistically significant (P=0.03).
Conclusion:Micronutrient deficiencies persist in IF patients during and after transition to enteral nutrition. These data support the need for routine monitoring and supplementation of these patients especially those on prolonged PN.


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