Original articles
Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes,☆☆

Presented in abstract form at the World Congress of Pediatric Gastroenterology and Nutrition, Boston, August 2000 (J Pediatr Gastroenterol Nutr 2000;31:S165).
https://doi.org/10.1067/mpd.2001.114481Get rights and content

Abstract

Objective: To determine correlates of clinical outcomes in patients with short bowel syndrome (SBS). Methods: Retrospective medical record review of neonates treated between 1986 and 1998 who met our criteria for SBS: dependence on parenteral nutrition (PN) for at least 90 days after surgical therapy for congenital or acquired intestinal diseases. Results: Thirty subjects with complete data were identified; 13 (43%) had necrotizing enterocolitis, and 17 (57%) had intestinal malformations. Mean (SD) residual small bowel length was 83 (67) cm. Enteral feeding with breast milk (r = –0.821) or an amino acid–based formula (r = –0.793) was associated with a shorter duration of PN, as were longer residual small bowel length (r = –0.475) and percentage of calories received enterally at 6 weeks after surgery (r = –0.527). Shorter time without diverting ileostomy or colostomy (r = 0.400), enteral feeding with a protein hydrolysate formula (r = –0.476), and percentage of calories received enterally at 6 weeks after surgery (r = –0.504) were associated with a lower peak direct bilirubin concentration. Presence of an intact ileocecal valve and frequency of catheter-related infections were not significantly correlated with duration of PN. In multivariate analysis, only residual small bowel length was a significant independent predictor of duration of PN, and only less time with a diverting ostomy was an independent predictor of peak direct bilirubin concentration. Conclusions: Although residual small bowel length remains an important predictor of duration of PN use in infants with SBS, other factors, such as use of breast milk or amino acid–based formula, may also play a role in intestinal adaptation. In addition, prompt restoration of intestinal continuity is associated with lowered risk of cholestatic liver disease. Early enteral feeding after surgery is associated both with reduced duration of PN and less cholestasis. (J Pediatr 2001;139:27-33)

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).

    ☆☆

    Reprint requests: Christopher Duggan, MD, MPH, Clinical Nutrition Service, Division of GI/Nutrition, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115.

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