Cognitive assessment in children with intestinal failure on and weaned off parenteral nutrition

OBJECTIVES: Children with intestinal failure (IF) are vulnerable to adverse cognitive outcomes. We assessed intelligence quotient (IQ) and identified associated factors. METHODS: Multicentre international cross-sectional study in children with IF and weaned children, treated at Erasmus MC Sophia Children's Hospital, Amsterdam UMC Emma Children's Hospital (both The Netherlands) and Birmingham Women's and Children's NHS Foundation Trust (UK). Primary outcomes were IQ outcomes using Wechsler's preschool and primary scale of intelligence (WPPSI-III), Wechsler intelligence scale for children (WISC-V) or Wechsler adult intelligence scale (WAIS-IV). Secondary outcomes were cognitive development outcomes, the correlation between IQ and possible related factors, and the linear relationship between the most influential factors and IQ outcomes using multiple linear regression. RESULTS: Fifty children were included: 50% boys; median age 9.1 (IQR 6.5-12.5) years; gestational age 34 (30-37) weeks; birth weight 2135 (1279-2545) grams; most common underlying condition was necrotising enterocolitis (28%); 21/50 children (42%) received home parenteral nutrition (PN), median PN-duration was 26.8 (7.5-66.5) months. Median IQ score was 92.0 (74.3-101.0), 15 children (30%) had very/extremely low IQ, both significantly different from the normal population (p < 0.001). Parental occupational and educational levels, number of line infections, and total hospital admission duration showed the strongest correlations with IQ outcomes, with line infections remaining significant after correction for multiple analyses (rho -0.52, p < 0.01). However, none were significant after multiple linear regression. CONCLUSIONS: Children with IF generally exhibit an average IQ but are at risk to have a below-average IQ. While separate factors were correlated with IQ outcomes, none remained significant after multiple linear regression. TRIAL REGISTRATION: ClinicalTrials.gov identifier: MEC 2019-098, NL-OMON54827, https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON54827.