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Extensive short-bowel syndrome in neonates: outcome in the 1980s
D A Caniano1, J Starr, M E Ginn-Pease
1Department of Pediatric Surgery, Children's Hospital, Columbus, OH 43205.
Insights
Neonates with extensive short bowel syndrome (SBS) face significant complications from total parenteral nutrition (TPN), but most achieve survival and can transition to enteral feeding.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Short bowel syndrome (SBS) is a severe condition in neonates requiring complex management.
- Extensive SBS, defined as ≤25% of normal jejunoileal length, presents unique challenges.
Purpose of the Study:
- To evaluate the outcomes of neonates with extensive SBS treated with total parenteral nutrition (TPN).
- To identify complications associated with TPN and assess long-term adaptation and survival.
Main Methods:
- Retrospective review of 14 infants with extensive SBS treated between 1978-1987.
- Analysis of causes of SBS, residual intestinal length, TPN-related complications, and patient outcomes.
Main Results:
- Common causes included gastroschisis and jejunal atresia; mean residual length was 16% of normal.
- TPN complications were frequent: catheter sepsis (93%), cholestasis (57%), central venous thrombosis (29%).
- Survival rate was 86%; 67% of survivors achieved enteral autonomy.
Conclusions:
- Despite high morbidity from TPN, neonates with extensive SBS can achieve survival and eventual enteral alimentation.
- Early management and monitoring are crucial for mitigating TPN-related complications and promoting intestinal adaptation.
Abstract:
Fourteen infants with extensive short-bowel syndrome (SBS) were treated from 1978 through 1987 at the Children's Hospital, Columbus, Ohio. Extensive SBS was defined as a residual jejunoileum that was 25% or less than the normal expected length for each infant's gestational age. The cause of the SBS included gastroschisis (5), jejunal atresia (5), necrotizing enterocolitis (2), midgut volvulus (1), and congenital SBS (1). Infants had a mean residual jejunoileal length of 32 cm, which represented an average of 16% of normal expected jejunoileal length for gestational age. The most significant complications were associated with total parenteral nutrition (TPN): catheter sepsis (13/14 infants); cholestasis (8/14); central venous thrombosis (4/14); and cholelithiasis (3/14). The survival rate was 86%; two infants died of end-stage liver disease. Eight of 12 survivors (67%) have had intestinal adaptation develop and have discontinued TPN; three are maintained with combined TPN-enteral feeding; and one receives only TPN. Mean cost of the initial hospitalization was $315,000 with an average stay of 450 days. Survival and eventual enteral alimentation may be expected for most neonates with extensive SBS despite significant morbidity.