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Massive small bowel resection in neonates--is weaning from parenteral nutrition the final goal?
1Department of Pediatric Surgery, Osaka University Medical School, Japan.
Insights
Pediatric patients with massive small bowel resection can achieve long-term nutritional independence. Intensive nutritional support is crucial for optimal growth and improved D-Xylose absorption in survivors.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutritional Science
Background:
- Massive small bowel resection in neonates presents significant long-term challenges.
- Congenital intestinal atresia and midgut volvulus are primary causes.
- Assessing long-term prognosis after neonatal massive small bowel resection is critical.
Purpose of the Study:
- To evaluate the long-term prognosis of pediatric patients following massive small bowel resection.
- To identify factors influencing nutritional independence and somatic growth.
- To document the incidence of metabolic complications.
Main Methods:
- Retrospective review of eight surviving pediatric patients (2-19 years follow-up).
- Analysis of residual small intestine length and ileocecal valve status.
- Assessment of nutritional status, growth parameters, and absorption tests (D-Xylose, fat).
Main Results:
- All patients were weaned from parenteral nutrition; six tolerate normal meals.
- Near-normal somatic growth achieved in 5/8 cases with intensive early nutritional treatment.
- D-Xylose absorption normalized in most cases; fat malabsorption noted with <45 cm residual intestine.
- Metabolic complications (renal calculi, cholelithiasis, fractures) occurred in 3/8 cases.
Conclusions:
- Long-term nutritional rehabilitation is achievable after neonatal massive small bowel resection.
- Early and intensive nutritional management significantly impacts somatic growth.
- Careful monitoring for metabolic complications is essential in long-term survivors.
Abstract:
Eight surviving cases from an original 15 pediatric patients who underwent massive small bowel resection during their neonatal period were reviewed for a period of 2-19 years to assess long-term prognosis. the primary diseases were congenital intestinal atresia in 6 cases and midgut volvulus in 2. The length of the residual small intestine ranged from 27-75 cm and the ileocaecal valve had been resected in 3 cases. All cases were able to be weaned from parenteral nutrition and at present, 6 of the children can tolerate normal meals but 2 are still receiving enteral nutrition, in the form of a low residue diet at home. Near normal somatic growth was achieved in the most recent 5 cases who received intensive nutritional treatment in the immediate postoperative period, whereas 3 who did not receive nutritional management exhibited growth retardation. The D-Xylose absorption test revealed gradual improvement and finally normal absorption in all except one case with the shortest remaining intestine (27 cm). However, the fat absorption test revealed abnormal absorption in cases with a residual intestine of less than 45 cm. Late metabolic complications such as renal calculi, cholelithiasis and pathologic fractures were encountered in 3 cases.