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Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: a 25-year

Rubén E Quirós-Tejeira1, Marvin E Ament, Laurie Reyen

  • 1Division of Gastroenterology and Nutrition, UCLA Medical Center, Los Angeles, California, USA. rquiros@bcm.tmc.edu

The Journal of Pediatrics
|August 4, 2004
PubMed

Insights

Children with short bowel syndrome (SBS) needing long-term parenteral nutrition (PN) have better survival with longer small bowel length and intact ileocecal valve. These factors also improve intestinal adaptation, allowing for a productive adulthood.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Nutritional Support

Background:

  • Short bowel syndrome (SBS) is a complex condition requiring long-term parenteral nutrition (PN) in children.
  • Understanding factors influencing survival and intestinal adaptation is crucial for managing these patients.

Purpose of the Study:

  • To analyze the outcomes of children with SBS who required long-term PN.
  • To identify predictors of survival and intestinal adaptation in this cohort.

Main Methods:

  • Retrospective analysis of 78 children with SBS requiring PN for over 3 months (1975-2000).
  • Statistical analysis included univariate analysis, Kaplan-Meier method, and Cox proportional regression.

Main Results:

  • Survival was significantly associated with greater small bowel length (SBL) (>38 cm), intact ileocecal valve (ICV), intact colon, and primary anastomosis.
  • Higher mortality was linked to PN-associated cholestatic jaundice and very short SBL (<15 cm).
  • Intestinal adaptation was less likely with removed ICV, colonic resection, and inability to achieve primary anastomosis.

Conclusions:

  • SBL, ICV integrity, intestinal continuity, and colon preservation are key for survival and adaptation in children with SBS on long-term PN.
  • Intestinal adaptation typically occurs within 3 years, and long-term PN does not preclude a productive adulthood.
  • Even with limited SBL, preserving the ICV offers a chance for adaptation.
Abstract

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