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Predicting time to full enteral nutrition in children after significant bowel resection
Jessica Gonzalez-Hernandez1, Purvi Prajapati2, Gerald Ogola2
1Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
Insights
Predicting time off parenteral nutrition (PN) for children post-bowel resection is crucial. Remaining small bowel length is the strongest predictor of PN independence, guiding clinical management.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Clinical nutrition
Background:
- Parenteral nutrition (PN) is associated with significant morbidity in pediatric patients following extensive bowel resection.
- Predicting the duration of PN dependence is essential for optimizing patient care and outcomes.
Purpose of the Study:
- To identify clinical variables that can predict the time to independence from PN in children after major intestinal resection.
- To evaluate the utility of these variables in estimating the duration of PN support.
Main Methods:
- Retrospective review of 71 children on PN for over 6 weeks post-intestinal resection who were successfully weaned.
- Analysis of clinical characteristics to determine their relationship with the time to achieve full enteral nutrition.
- Statistical analysis with significance set at P < 0.05.
Main Results:
- Small bowel length (P < 0.01) and percent of expected small bowel length based on gestational age (P < 0.01) were strongly associated with PN duration.
- Children with 25-50% of expected small bowel length required approximately 2 years of PN, versus 1 year for those with 51-75%.
- Etiology of intestinal loss, presence of ileocecal valve/colon, or anastomosis location did not significantly impact PN duration.
Conclusions:
- Remaining small bowel length is the most reliable predictor of PN duration in children after major bowel resection.
- A linear regression model utilizing small bowel length can estimate the time to PN independence.
Purpose:
Parenteral nutrition (PN) contributes to considerable morbidity in children after significant bowel resection. This study evaluates the utility of clinical variables in predicting time to independence from PN.
Methods:
After IRB approval, a retrospective review (1999-2012) of 71 children who were on PN for >6weeks after intestinal resection and successfully weaned was performed. Clinical characteristics were evaluated to determine the relationship to time to full enteral nutrition. P-values<0.05 were significant.
Results:
Most children had necrotizing enterocolitis (56%), intestinal atresia (20%), or gastroschisis (11%) with a median small bowel length of 55cm (IQR, 35-92cm). The duration of PN was independent of the etiology of intestinal loss, presence of the ileocecal valve or colon, or location of anastomosis, but was strongly associated with small bowel length (<0.01) and percent of expected small bowel based on gestational age (GA) (median 50%, <0.01). In general, children who had 25-50% of their small bowel were dependent on PN for at least 2years compared to approximately 1year for those with 51-75%.
Conclusion:
The duration of PN dependence in children after major bowel resection is best predicted by remaining small bowel length and can be estimated using a linear regression model.
Level Of Evidence:
2b.
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