Background: Gastrointestinal dysmotility is common in pediatric intestinal failure patients (PIF), leading to delays in advancement of enteral nutrition (EN) and inability to wean parenteral nutrition (PN). Data on the safety and efficacy of Cisapride® for this purpose is scarce.

Objectives: Describe a single center experience with Cisapride® and its impact on enteral nutrition progression in patients with IF. 

Study design: Retrospective cohort study of PIF patients managed in a multidisciplinary intestinal rehabilitation program between January 2008 - December 2015. Percentage of EN prior to initiation of Cisapride® (proportion of overall kcal/kg being delivered enterally), progression of EN percentage at 3 and 6 months and ability to wean PN were calculated. Rate of progression per day in the 3 months pre and post Cisapride were also evaluated. Side effects were recorded to characterize safety of Cisapride® use.

Results: There was no statistical difference in patient demographics or anatomy between patients who were treated with Cisapride versus other prokinetics. Use of any prokinetic was identified in 61/106 patients (57.5%), 29/61 patients (47.5%) failed to advance EN on other prokinetics and started on Cisapride®. Before initiation of Cisapride® the progression of EN had plateaued for a mean of 42.3±60.2 days. The rate of advancement of EN volume progression rate pre Cisapride® was 0.14%/day±0.19%/day and after Cisapride® initiation improved significantly to 0.69%/day±0.31%/day (p < 0.001). Percentage of EN tolerance 3 months after initiation of Cisapride® significantly improved compared to baseline (23.9% vs 79.4 % respectively; p < 0.001). Cisapride® was discontinued in 2/29 (6.8%) patients (1 for prolonged QTc and 1 as a precaution due to cardiomegaly secondary to selenium deficiency).

Conclusion: Cisapride® can be beneficial in PIF patients who have failed to progress EN after using other first line prokinetics. The most significant period of improved EN intake occurred within 3 months of Cisapride® initiation. Cardiac side effects in our cohort were lower than previously reported, however cardiac monitoring is still recommended.