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Refined Multidisciplinary Protocol-Based Approach to Short Bowel Syndrome Improves Outcomes
Laura Merras-Salmio1, Mikko P Pakarinen
1*Pediatric Liver and Gut Research Group, Department of Pediatric Gastroenterology †Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
A refined multidisciplinary approach significantly improved short bowel syndrome (SBS) care, reducing parenteral nutrition (PN) duration and catheter-related infections (CRIs). This enhanced patient survival and prevented liver failure in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Short bowel syndrome (SBS) management has seen recent advancements.
- A single-center, 25-year experience is presented focusing on a refined multidisciplinary SBS care protocol.
Purpose of the Study:
- To evaluate the impact of a refined multidisciplinary SBS care protocol implemented in 2009.
- To compare outcomes of SBS patients before and after protocol implementation.
Main Methods:
- Retrospective review of 48 SBS patients treated from 1988 to 2014.
- Exclusion of patients with primary intestinal motility disorders.
- Analysis of clinical characteristics, cholestasis markers, and catheter-related infections (CRIs).
Main Results:
- Overall survival improved from 88% to 95% post-protocol.
- Parenteral nutrition (PN) duration decreased from 15 to 6 months (P=0.0015).
- Catheter-related infection (CRI) rates decreased from 1.7 to 0.7 per 1000 catheter-days (P=0.0178).
- Neonatal cholestasis cleared in all patients after 2009.
Conclusions:
- A uniform, refined multidisciplinary approach reduced PN duration and CRI rates.
- High transplant-free survival and avoidance of liver failure were achieved.
- Transient neonatal cholestasis frequency remained unchanged.
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