Pediatric Intestinal Failure and Liver Disease: Advances in Pathogenesis, Diagnosis, Early Intervention, and Outcomes

Intestinal failure–associated liver disease (IFALD) is a major concern in the management of pediatric intestinal failure, representing a leading cause of morbidity and mortality among affected children. Despite substantial progress in neonatal intensive care, nutritional support, and surgical techniques, the onset and progression of IFALD continue to complicate care and significantly impact long-term outcomes. Pediatric intestinal failure arises from a range of underlying causes—including short bowel syndrome, congenital enteropathies, and motility disorders—yet the emergence of secondary liver disease introduces further complexity, involving multifactorial pathophysiology and demanding comprehensive longitudinal management strategies. Ongoing debates surround the mechanisms by which chronic parenteral nutrition, altered bile metabolism, inflammation, dysbiosis, and immune responses intersect to drive liver injury in this vulnerable population.Recent studies have shed light on the intricate interplay of gut-liver axis alterations, microbiome disruption, nutritional imbalances, lipid emulsions, and genetic predispositions in the evolution of IFALD. Innovations in early biomarker discovery, non-invasive imaging modalities, and the optimization of parenteral nutrition regimens have improved the capacity to monitor and manage hepatic injury. Nevertheless, substantial gaps remain in predicting which patients will develop IFALD, distinguishing reversible from progressive liver injury, and establishing uniform standards for monitoring, prevention, and treatment. Moreover, there is a pressing need for therapies that can not only support intestinal adaptation but also specifically mitigate liver disease, thereby enabling safer transitions to enteral autonomy and reducing dependence on transplantation.This Research Topic aims to deepen the understanding of IFALD within the broader context of pediatric intestinal failure, with a primary goal of advancing knowledge on pathogenesis, early diagnosis, risk stratification, prevention, and management. By integrating new evidence from basic research, clinical studies, and multidisciplinary perspectives, this initiative seeks to clarify key determinants of liver injury, explore protective strategies, and highlight emerging therapies designed to improve both short- and long-term hepatic and overall outcomes for children.Focusing specifically on the intersection of pediatric intestinal failure and associated liver disease, this Research Topic prioritizes articles that explore hepatic pathogenesis, early diagnostic innovations, and multifaceted management approaches. To gather further insights, we welcome articles addressing, but not limited to, the following themes:o Cellular and molecular mechanisms of IFALD in childreno Role of parenteral nutrition composition and management of hepatotoxicityo Innovations in biomarkers, imaging, and early detection of liver injuryo Preventive measures and therapeutic strategies for IFALDo Interactions between the gut microbiome, immune response, and liver inflammationo Multidisciplinary care models integrating hepatology and nutritiono Challenges in weaning from parenteral nutrition and achieving liver recoveryo Surgical interventions and their effects on hepatic outcomeso Long-term monitoring, growth trajectories, neurodevelopment, and quality of life in the context of IFALDo Transition of pediatric patients with IFALD to adult care Topic editors: Maurizio Giordano, MARIA Immacolata SPAGNUOLO, Giuseppe De Bernardo Source: https://www.frontiersin.org/research-topics/79093/pediatric-intestinal-failure-and-liver-disease-advances-in-pathogenesis-diagnosis-early-intervention-and-outcomes