Pediatric Neurogastroenterology by Christophe Faure Carlo Di Lorenzo & Nikhil Thapar

Author:Christophe Faure, Carlo Di Lorenzo & Nikhil Thapar
Language: eng
Format: epub
Publisher: Humana Press, Totowa, NJ

Outcomes

The prognosis of children with CIPO remains guarded, with risk of mortality as high as 30% in the first year of life. Complications of parenteral nutrition are the cause of death in a majority of children [103, 104]. Thus, TPN is life saving, but measures to avoid TPN and, once started, to discontinue TPN are appropriate. Children with lower socioeconomic status tend to be on TPN longer than children from high socioeconomic status, suggesting that those with better health care access are aggressively moved away from parenteral nutrition [103]. The quality of life for surviving children with pseudo-obstruction and their families is reduced compared to others with chronic disease [103]. The factors responsible for reduced quality of life in CIP were chronic pain and the caretaker’s time commitment for participating in their child’s medical care [103]. Adverse prognostic factors include early onset disease, enteric myopathies, associated malrotation, and absent phase 3 of the migrating motor complex on small intestinal manometry. A few children with congenital neuropathic CIPO improve with time. Several factors may be responsible. First, caloric needs are greatest in the first year, and decrease in subsequent years. Thus, the infant who can digest 50% of his or her caloric needs in the first year, may have no change in motility, but digest 100% of his or her lessening caloric needs in subsequent years. Second, motility may improve spontaneously. The mechanisms for improvement in this small group are unexplained.

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