Enteral autonomy in pediatric short bowel syndrome: predictive factors one year after diagnosis.

Abstract

PURPOSE:

This study examined predictors of achieving enteral autonomy among pediatric short bowel syndrome (SBS) patients remaining on parenteral nutrition (PN) beyond one year.

METHODS:

A retrospective single-institution study of 171 pediatric SBS patients (defined as ≥50% small bowel (SB) loss or ≥60 days of PN with onset before 6 weeks of age) was performed. Multivariate Cox proportional hazards analysis was conducted, with subgroup analysis of patients on PN for ≥1 year (n=59). Primary outcome was successful wean from PN.

RESULTS:

Over a follow-up of 4.1±4.8 years, 64.3% of children weaned from PN. Mortality was 15.2%. Presence of ≥10% expected SB length (hazard ratio [HR] 6.48, p=0.002) or an ileocecal valve (ICV; HR, 2.86, p<0.001) predicted PN weaning. Of those on PN ≥1 year, the wean rate was 50.8%, and ICV no longer predicted weaning (p=0.153). Predictors among those on PN ≥1 year were: ≥10% expected SB length (HR, 8.27, p=0.010), intestinal atresia (HR, 4.26, p=0.011), and necrotizing enterocolitis (NEC, HR, 2.84, p=0.025).

CONCLUSIONS:

SBS children on PN ≥1 year continue to wean from PN, and those with ≥10% of predicted SB length, NEC, or atresia are more likely to do so. These findings may help direct management and advice for these challenging patients.

• Authors: Farokh R Demehri, Lauren Stephens, Emma Herrman, Brady West, Ann Mehringer, Meghan A Arnold, Pamela I Brown, Daniel H Teitelbaum
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 50 Issue 1 Pg. 131-5 (Jan 2015) ISSN: 1531-5037 [Electronic] United States
• PMID: 25598109 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Topics

• Child
• Child, Preschool
• Female
• Humans
• Infant
• Male
• Multivariate Analysis
• Parenteral Nutrition
• Proportional Hazards Models
• Retrospective Studies
• Short Bowel Syndrome (mortality, therapy)