Original articlesNutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes☆,☆☆
Section snippets
METHODS
We performed a retrospective review of the medical records of all patients born at Children’s Hospital, Boston, in 1985 or later who fit our definition of SBS. We defined SBS as dependence on PN for at least 90 days for diagnoses resulting from congenital intestinal malformations and/or intestinal resection. We restricted our study to patients who were given a diagnosis of SBS in the neonatal period (age <30 days). The primary outcome variables were duration of PN use and peak serum direct
RESULTS
Thirteen (43%) of the patients had necrotizing enterocolitis, and 17 (57%) had congenital gastrointestinal malformations (Table I).Median residual small bowel length was 61 cm. The ileocecal valve was preserved in 57% of the patients. The shortest duration of PN use was 101 days, the longest was 3287 days, and the median was 245 days.
Of the 30 patients in the study, 20 (67%) were weaned from PN; 9 of the 10 PN-dependent patients died while receiving PN. The causes of death were progressive
DISCUSSION
Our study indicates that longer residual small bowel, higher percentage of calories received enterally at 6 weeks, and enteral feeding with breast milk or an amino acid–based formula are associated with shorter duration of PN. Longer residual small bowel, shorter time with a diverting ostomy, fewer Gram-positive infections, and feeding with a protein hydrolysate formula are associated with a lower peak direct bilirubin concentration.
Previous case series have identified residual small bowel
Acknowledgements
We thank Drs Glenn Furuta, Athos Bousvaros, and Moritz Ziegler for comments on earlier drafts.
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David Andorsky was supported by the American Society for Clinical Nutrition (National Clinical Nutritional Internship) and the Harvard Medical School Office for Enrichment Programs; Christopher Duggan was supported by the Clinical Nutrition Research Unit at Harvard (NIH P30-DK40561).
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Reprint requests: Christopher Duggan, MD, MPH, Clinical Nutrition Service, Division of GI/Nutrition, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115.