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Decrease of cholestasis under "continuous extracorporeal stool transport (CEST)" in prematures and neonates with
K Schäfer1, A Schledt, O Linderkamp
1Department of Pediatric Surgery, University of Heidelberg, Germany. Klemens.Schaefer@t-online.de
Insights
Continuous extracorporeal stool transport (CEST) significantly reduces cholestasis risk in very low birth weight (VLBW) infants with surgical intestinal conditions. This method also decreases the need for parenteral nutrition compared to conventional treatments.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Intensive care medicine
Background:
- Increasing incidence of very low birth weight (VLBW) neonates with surgical intestinal issues.
- VLBW infants with intestinal malformations often require split stoma surgery.
- Short-bowel syndrome in neonates poses risks of cholestasis and need for parenteral nutrition.
Purpose of the Study:
- To evaluate the efficacy of continuous extracorporeal stool transport (CEST) in reducing cholestasis risk.
- To compare cholestasis rates in infants treated with CEST versus conventional methods.
- To assess the impact of CEST on the requirement for parenteral nutrition.
Main Methods:
- Prospective study of 33 infants treated with CEST (1994-1998).
- Retrospective analysis of 26 infants treated conventionally (1987-1993).
- Comparison of hyperbilirubinemia incidence and parenteral nutrition dependency between groups.
Main Results:
- Significantly lower cholestasis risk in the CEST group (12.9%) compared to the conventional group (38.5%).
- Only 3% of infants in the CEST group required permanent parenteral nutrition.
- Conventional treatment led to 50% of patients requiring permanent parenteral nutrition.
Conclusions:
- CEST is an effective method for managing VLBW infants with surgical intestinal conditions.
- CEST significantly reduces the incidence of cholestasis and the need for long-term parenteral nutrition.
- This approach offers a promising alternative for improving outcomes in neonates with short-bowel syndrome.
Abstract:
According to recent studies, the percentage of neonates suffering a combination of very low birth weight (VLBW) and intestinal malformation or diseases that require surgery has increased. As opposed to mature newborn, split stoma is the therapy of choice in VLBW infants. These neonates and patients with other causes for a congenital or acquired short-bowel syndrome usually require parenteral nutrition and have a high risk of a cholestasis. Until 1993, stoma patients were treated with a special diet in our department, but depending of the stoma site often required parenteral nutrition, while the non-used distal bowel was irrigated with an isotonic electrolyte solution. With this regime, up to 38.5% of the treated patients (10126) were found to have a hyperbilirubinemia (> 3 mg/dl) after the 21st day of life. 1994, we started to use a device that continuously transfers the intestinal chylus from the proximal into the aboral bowel via a pump like a continuous extracorporeal stool transport (CEST). In this study, we evaluated the risk of cholestasis by comparison of the prospectively investigated group (CEST-group 1994-1998) of 33 infants with the results of the retrospectively studied group of 26 patients operated on between 1987 and 1993. We found a significantly lower risk of cholestasis in the CEST-Group (12.9% versus 38.5%; p<0.04). Only 3% of our patients with CEST (one patient) required permanent parenteral nutrition, compared to 50% of the conventionally treated patients.