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[Extensive small intestinal resection in newborn infants]
O Goulet1, C Maurage, Y Revillon
1Service de Gastroentérologie et Nutrition et de la Clinique Chirurgicale Infantile, Hôpital des Enfants-Malades, Paris.
Insights
Survival rates and intestinal adaptation in infants with extensive small bowel resection significantly improved after 1980, with longer residual small bowel length and the presence of the ileocecal valve being key factors.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastroenterology
Context:
- Analyzes 83 infants undergoing extensive small bowel resection from 1970-1987.
- Resection causes included atresia, volvulus, gastroschisis, and vascular enteropathy.
- Patients grouped by residual small bowel length: <40 cm (Group I) and 40-80 cm (Group II).
Purpose:
- To evaluate factors influencing survival and intestinal adaptation post-resection.
- To assess the impact of residual bowel length and ileocecal valve presence.
- To determine the role of nutritional support in recovery.
Summary:
- Survival rates were higher with longer residual small bowel (92% in Group II vs. 63.6% in Group I).
- Birth after 1980 correlated with improved survival (95% vs. 65%).
- Intestinal autonomy acquisition time varied by bowel length and ileocecal valve presence, with shorter times for Group II (14 months vs. 29.5 months).
Impact:
- Demonstrates improved outcomes in recent decades for neonates with short bowel syndrome.
- Highlights the critical role of residual bowel length and ileocecal valve in adaptation.
- Confirms the efficacy of artificial nutrition, including home parenteral nutrition, for growth and family reintegration.
Abstract:
This retrospective study analyzes the management of 83 infants who had undergone extensive small bowel resection as newborns between 1970 and 1987. Resection was performed for atresia (n = 34), volvulus (n = 21), laparoschisis (n = 10), vascular enteropathy (n = 10) and other disorders in 8 cases. The patients were divided into two groups: Group I (33 children) has less than 40 cm and Group II (50 children) 40-80 cm of residual small bowel respectively. Survival depended on the length of residual small bowel (Group I: 63.6%, Group II: 92%) and on their date of birth (born before 1980: 65%, after 1980: 95%). The time required for acquisition of intestinal autonomy depended on the intestinal length (average time, 29.5 months for Group I and 14 months for Group II) and especially on the presence of the ileocecal valve. The residual ileal and/or colon length also influenced adaptation. Artificial parenteral and/or enteral nutrition ensured normal height/weight increases. Home parenteral nutrition allowed children to be returned to their families during intestinal adaptation.