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Published on: December 1, 2012
[Outcome and survival of pediatric Short Bowel Syndrome (SBS)]
M Martínez1, M Fabeiro, M Dalieri
1Servicio de Nutrición y Dietoterapia, Hospital de Niños Sor María Ludovica, Buenos Aires, Argentina.
Insights
Short bowel syndrome (SBS) in children has high mortality, but about one-third can adapt over time. Adaptation is linked to bowel anatomy, while shorter residual bowel length and cholestasis increase mortality risk.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Clinical Nutrition
Context:
- Short bowel syndrome (SBS) is a primary cause of intestinal failure (IF) in children, associated with significant morbidity and mortality.
- Pediatric IF necessitates complex management strategies, impacting long-term outcomes.
Purpose:
- To investigate factors influencing the clinical outcomes and survival rates of pediatric patients with SBS.
- To identify predictors of adaptation, parenteral nutrition dependence, transplantation, and mortality in this cohort.
Summary:
- This retrospective study analyzed 63 children with SBS (residual bowel length ≤ 40 cm). Outcomes were categorized into dead (33%), adapted (27%), parenteral nutrition dependent (30%), and transplanted (10%).
- Adapted patients demonstrated longer residual bowel length and more preserved colon. Survival rates at 1, 2, and 3 years were 86%, 70%, and 66%, respectively.
- Mortality was associated with shorter residual bowel length, cholestasis, and earlier admission dates. Hepatic failure was the leading cause of death.
Impact:
- Findings highlight the critical role of residual bowel length and colon preservation in successful adaptation for pediatric SBS.
- Identifies key risk factors for mortality, including cholestasis and limited bowel length, informing clinical management and prognostic assessments.
- Suggests that adaptation can occur over several years, emphasizing the need for sustained multidisciplinary care in pediatric intestinal failure.
Introduction:
SBS is the main cause of intestinal failure (IF) in children and has a high morbility and mortality.
Objectives:
to analyze factors associated with the outcome and survival of SBS children.
Methods:
analytical, descriptive and retrospective study. We include patients with residual bowel length (RBL) ≤ 40 cm. OUTCOME is analyzed in groups: dead (D), adapted (A), parenteral nutrition dependant (NPD), and transplanted (Tx) according to: bowel anatomy, diagnosis, prematurely, year of beginning of IF, duration of IF, cholestasis (CB > 2 mg/dl) and thrombosis. Survival is analyzed with Kaplan Meier.
Results:
63 patients were included: RBL x 21 ± 11 cm, preserved colon 46%, prematures 41%, neonatal resection 78%, duration of IF x 0.66 years. 54% had cholestasis (CB x 5.29 ± 2.35 mg/dl) and 25% had thrombosis.
Outcome:
D 33%, A 27%, PND 30% and Tx 10%. Adapted patients had longer RBL (p 0.001) and more preserved colon (p 0.017). 1 year survival was 86%, 2 years 70% and 3 years 66%. Age at death: x 2.3 years. Causes of death: hepatic failure 62%, lack of venous access 19%, sepsis 10%, others 10%. Factors related to death were shorter RBL (p 0.045), cholestasis (0.049, admittance to the center before 2000 (p 0.02).
Conclusions:
SBS had a high mortality and 1/3 of patients could adapt requiring up to 5 years. Adaptation was in relation to anatomic factors. Mortality was related to.
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