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Eur J Pediatr Surg 2018; 28(05): 455-463
DOI: 10.1055/s-0037-1604113
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pediatric Short Bowel Syndrome: Predicting Four-Year Outcome after Massive Neonatal Resection

Teresa Capriati
1   Artificial Nutrition Unit, Ospedale Pediatrico Bambino Gesu, Roma, Italy
,
Daniela Giorgio
1   Artificial Nutrition Unit, Ospedale Pediatrico Bambino Gesu, Roma, Italy
,
Fabio Fusaro
2   Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
,
Manila Candusso
3   Department of Gastroenterology, Hepatolgy and Nutrition Unit, Ospedale Pediatrico Bambino Gesu, Rome, Italy
,
Paolo Schingo
4   Department of Imaging, Ospedale Pediatrico Bambino Gesu, Rome, Italy
,
Tamara Caldaro
5   Department of Digestive surgery, Bambino Gesù Children's Hospital, Rome, Italy
,
Francesca Laureti
1   Artificial Nutrition Unit, Ospedale Pediatrico Bambino Gesu, Roma, Italy
,
Domenica Elia
1   Artificial Nutrition Unit, Ospedale Pediatrico Bambino Gesu, Roma, Italy
,
Antonella Diamanti
1   Artificial Nutrition Unit, Ospedale Pediatrico Bambino Gesu, Roma, Italy
› Author Affiliations
Further Information

Publication History

04 February 2017

28 May 2017

Publication Date:
18 July 2017 (online)

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Abstract

Objectives The aim of this study was to ascertain predictors of survival, liver disease (LD), and enteral autonomy 48 months after resection in neonatal short bowel syndrome (SBS) patients with residual small bowel length (SBL) ≤40 cm.

Patients and Methods Medical records of all SBS patients followed up between 1996 and 2016 were retrospectively reviewed. Survival rate, prevalence of LD, and of enteral autonomy were evaluated.

Results Forty-seven patients were included, and 43 were still alive at the end of the study period, with cumulative 48-month survival of 91.5%. Twenty-one (45%) patients developed LD, all within the first 6 months. On the final follow-up visit, three (6%) patients were still jaundiced and progressed toward end-stage LD. LD prevalence was higher in patients with recurrent bloodstream infections (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.5–19.3). Of the 43 surviving patients, 22 (51%) had enteral autonomy 48 months after resection. The probability of weaning off parenteral nutrition (PN) was strongly correlated with the remaining SBL.

Conclusion Survival of patients who have undergone neonatal massive small bowel resection has improved in recent years. Multidisciplinary strategies can improve the course of LD, but not the probability of weaning off PN, which seems to be strongly dependent on the anatomical profile of residual bowel. Therefore, the primary surgical approach should be as conservative as possible to gain even small amounts of intestinal length, which may be crucial in promoting intestinal adaptation.

Keywords

intestinal failure - short bowel syndrome - pediatric - enteral adaptation
 

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