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Morbidity and mortality of short bowel syndrome in infancy and childhood
D Anagnostopoulos1, J Valioulis, D Sfougaris
1Pediatric Surgical Clinic, Aristotelian University, Thessaloniki, Greece.
Insights
Short bowel syndrome in 59 children, often from necrotizing enterocolitis, required surgical intervention and nutritional support. Intestinal adaptation took months, with 80% survival despite complications like sepsis and liver dysfunction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Short bowel syndrome (SBS) is a severe condition in infants and children, frequently resulting from necrotizing enterocolitis.
- Management of SBS involves complex surgical and nutritional strategies to promote intestinal adaptation.
Purpose of the Study:
- To review surgical management and outcomes for 59 pediatric patients with short bowel syndrome.
- To identify factors influencing intestinal adaptation and survival rates in this cohort.
Main Methods:
- Surgical procedures included bowel resection, tapering enteroplasty, primary anastomosis, and temporary enterostomies.
- Patients received total parenteral nutrition (TPN) and early enteral feedings, with home hyperalimentation initiated when enteral intake reached 50% of caloric needs.
- Second-look laparotomy was utilized for assessing questionable bowel viability.
Main Results:
- The mean length of remaining bowel was 58.4 cm; the ileocecal valve was resected in 32 patients.
- Intestinal adaptation ranged from 3 to 14 months, with common setbacks including catheter sepsis, rotavirus, carbohydrate intolerance, and liver dysfunction.
- The overall survival rate was 80%, with mortality linked to TPN-associated sepsis and liver failure.
Conclusions:
- Surgical interventions and comprehensive nutritional support are critical for managing pediatric short bowel syndrome.
- Early enteral feeding and careful monitoring are essential for successful intestinal adaptation and improved survival rates.
- Complications such as sepsis and liver dysfunction remain significant challenges in the long-term care of these patients.
Abstract:
This report concerns 59 infants and children with short bowel syndrome, most commonly caused by necrotizing enterocolitis in this study. Resection of atretic or gangrenous bowel was performed in 53 patients, tapering enteroplasty and primary anastomosis was performed in 13 patients, and temporary enterostomies were performed in 40 patients. Second-look laparotomy was useful in two of four cases of questionable bowel viability. The ileocecal valve was resected in 32 patients and remained intact in 27. The mean length of the remaining bowel was 58.4 cm. All patients received total parenteral nutrition and early enteral feedings. Home hyperalimentation was attempted when 50 per cent of the calorie intake was enteral. Intestinal adaptation required from 3 to 14 months. Frequent setbacks were related to catheter sepsis, rotavirus infection, carbohydrate intolerance, and liver dysfunction. The overall survival rate was 80 per cent with mortality due to sepsis associated with total parenteral nutrition and liver failure.