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

J Pediatr. 2013 Dec;163(6):1692-6. doi: 10.1016/j.jpeds.2013.07.015. Epub 2013 Aug 24.

Abstract

Objectives: To determine the prevalence of deficiencies of specific micronutrients (iron, zinc, magnesium, phosphorus, selenium, copper, folate, and vitamins A, D, E, and B12) in children with intestinal failure (IF), and to identify risk factors associated with developing these deficiencies.

Study design: This study was a retrospective review of prospectively collected data from 178 children with IF managed by the Intestinal Care Center of Cincinnati Children's Hospital Medical Center between August 1, 2007, and July 31, 2012. Transition to full enteral nutrition (FEN) was defined as the period during which the patient received between 20% and 100% of estimated required nutrition enterally. FEN was defined as the patient's ability to tolerate 100% estimated required nutrition enterally for >2 weeks.

Results: Necrotizing enterocolitis was the most common cause of IF (27.5%). Iron was the most common micronutrient deficiency identified both during (83.9%) and after (61%) successful transition to FEN, with a significant reduction in the percentage of patients with iron deficiency between these 2 periods (P = .003). Predictors of micronutrient deficiency after successful transition to FEN included birth weight (P = .03), weight percentile (P = .02), height percentile (P = .04), and duration of parenteral nutrition (PN) (P = .013). After multivariate adjustments, only duration of PN remained statistically significant (P = .03).

Conclusion: Micronutrient deficiencies persist in patients with IF during and after transition to FEN. These data support the need for routine monitoring and supplementation of these patients, especially those on prolonged PN.

Keywords: EN; Enteral nutrition; FEN; Full enteral nutrition; HAZ; Height-for-age z-score; IF; Intestinal failure; PN; Parenteral nutrition; WAZ; Weight-for-age z-score.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Deficiency Diseases / epidemiology
  • Deficiency Diseases / etiology
  • Enteral Nutrition*
  • Female
  • Humans
  • Intestinal Diseases / complications
  • Intestinal Diseases / therapy*
  • Male
  • Micronutrients / deficiency*
  • Prevalence
  • Retrospective Studies

Substances

  • Micronutrients