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Intestinal adaptation in pediatric patients with short-bowel syndrome
Insights
Pediatric short-bowel syndrome (SBS) patients showed good survival with nutritional support. Over 16 cm of residual intestine is key for weaning from total parenteral nutrition (TPN).
Area of Science:
- Pediatric Gastroenterology
- Surgical Nutrition
- Intestinal Adaptation
Background:
- Short-bowel syndrome (SBS) presents significant challenges in pediatric patients.
- Nutritional management is critical for survival and adaptation in SBS.
- Intestinal length and metabolic factors influence outcomes.
Purpose of the Study:
- To evaluate outcomes in pediatric SBS patients.
- To determine the required residual intestinal length for adaptation.
- To analyze metabolic characteristics and nutritional support efficacy.
Main Methods:
- Retrospective analysis of 12 pediatric SBS patients.
- Assessment of residual intestinal length and ileocecal valve status.
- Monitoring of total parenteral nutrition (TPN) to enteral nutrition transition and clinical outcomes.
Main Results:
- Eight of 12 patients were weaned from TPN, with a mean residual intestine of 57 cm.
- Patients unable to adapt had a mean residual intestine of 22 cm.
- A residual intestinal length >16 cm predicted successful TPN weaning; low catheter-related sepsis (0.63/1000 days) and no progressive liver failure observed.
Conclusions:
- Nutritional support programs ensure excellent survival in pediatric SBS.
- Residual intestinal length is a critical predictor of successful adaptation and TPN weaning.
- Monitoring plasma amino acids like arginine and citrulline may offer insights into adaptation.
Abstract:
The purpose of this study is to evaluate 12 pediatric short-bowel syndrome (SBS) patients experienced at Osaka University Hospital and its affiliated hospitals and to study the intestinal length for achieving intestinal adaptation and the metabolic characteristics. The length of the residual small intestine ranged from 0 to 75 cm with an average of 47 cm and an ileocecal valve had been resected in five cases. Total parenteral nutrition (TPN) was started immediately after operation and was gradually substituted by enteral nutrition. No patient died during the follow-up period. Eight of 12 patients could be weaned from TPN with residual intestinal length of 27 to 75 cm (mean 57 cm). Four patients with the residual intestine of 0 to 45 cm (mean 22 cm) were unable to achieve intestinal adaptation. The rate of catheter-related sepsis per 1000 catheter days was 0.63. Fatty liver was detected in two cases, but no patient developed progressive liver failure. Plasma arginine and citrulline were decreased in patients who were unable to achieve intestinal adaptation. Our nutritional support program provided excellent survival for pediatric SBS patients primarily due to the low incidence of catheter-related sepsis and no episode of severe liver disease. Patients with more than 16 cm of residual intestinal length can be expected to be weaned from TPN.