99 - Current State of Neonatal Intestinal Rehabilitation Care in North American level IV NICUs: A multi-institutional survey

Poster Number: 99
Publication Number: 99.366

Background: Multidisciplinary care under intestinal rehabilitation programs (IRP) improve survival in pediatric intestinal failure patients. In 2017 the North American Society for Pediatric Gastroenterology Hepatology and Nutrition endorsed management of pediatric patients with intestinal failure by, or in close consultation with, an IRP. It is currently unclear if these recommendations are followed for patients treated in the Neonatal Intensive Care Unit (NICU).

Objective: To describe the current state of neonatal intestinal rehabilitation care practices across level IV NICUs participating in the Children’s Hospital Neonatal Consortium (CHNC).

Design/Methods: An internet-based electronic survey was sent to all CHNC sites in July 2023 with reminder emails sent between July and September 2023. The survey consisted of adaptive questioning and contained between 10 and 52 questions dependent on respondent answers. The survey covered topics regarding intestinal failure care including: diagnosis, IRP use and description, protocol management, and outpatient follow-up.

Results: A total of 93% of centers (42/45) responded to the survey. The majority, 55% (23/42), of centers do not have a specific definition for intestinal failure in the NICU. Twenty-one percent (9/42) of centers report having no IRP in the NICU. The composition and the use of the IRP team varied by center (Table 1). Only 60% (25/42) of centers had protocols for management of intestinal failure in the NICU. The protocol contents varied by center with 100% of centers including parenteral nutrition, intravenous lipid emulsion usage, and laboratory monitoring, 88% enteral nutrition, 16% ethanol lock usage, and 8% heparin lock usage. An additional 12% of protocols included other topics such as cholestasis treatment, small bowel bacterial overgrowth, and medication usage such as dysmotility agents. The specific contents of the protocols are described in Figure 1. At the time of discharge, the care of intestinal failure neonates further differed by center (Table 2). Only 76% (32/42) report a formal multidisciplinary intestinal failure rehabilitation clinic with follow-up varying by center (Table 2).

Conclusion(s): The care of neonatal intestinal failure patients across CHNC centers in North America is highly variable despite most centers having a formal IRP. While the presence of an IRP is known to enhance patient outcomes, this variability in neonatal intestinal failure patient care warrants further study. By identifying the best practices and their influence, further standardization of intestinal failure care in the NICU could improve patient outcomes.