Enteral autonomy in pediatric short bowel syndrome: predictive factors one year after diagnosis

Area of Science:

• Pediatric Gastroenterology
• Surgical Gastroenterology
• Clinical Nutrition

Background:

• Short bowel syndrome (SBS) is a complex condition requiring long-term parenteral nutrition (PN) in pediatric patients.
• Achieving enteral autonomy is a critical goal for improving quality of life and reducing PN-related complications.
• Predictors for successful weaning from PN in pediatric SBS patients are not fully elucidated, especially for those requiring prolonged nutritional support.

Purpose of the Study:

• To identify predictors of achieving enteral autonomy (weaning from PN) in pediatric patients with short bowel syndrome.
• To specifically analyze factors influencing PN weaning in a subgroup of patients on PN for one year or longer.

Main Methods:

• Retrospective analysis of 171 pediatric SBS patients.
• Definition of SBS: ≥50% small bowel loss or ≥60 days of PN before 6 weeks of age.
• Multivariate Cox proportional hazards analysis, including subgroup analysis for patients on PN ≥1 year.

Main Results:

• Overall, 64.3% of pediatric SBS patients weaned from PN over a mean follow-up of 4.1 years; mortality was 15.2%.
• Predictors for weaning included ≥10% expected small bowel length and presence of an ileocecal valve.
• In patients on PN ≥1 year (n=59), 50.8% weaned; predictors were ≥10% expected small bowel length, intestinal atresia, and necrotizing enterocolitis (NEC).

Conclusions:

• Pediatric SBS patients on PN for over a year can achieve enteral autonomy.
• Remaining small bowel length, intestinal atresia, and NEC are significant predictors for successful PN weaning in this prolonged-support group.
• These findings can guide management strategies for challenging pediatric SBS cases requiring extended PN support.