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Small Proportion of Low-Birth-Weight Infants With Ostomy and Intestinal Failure Due to Short-Bowel Syndrome Achieve
Anne L Smazal1, L Adriana Massieu2, Laura Gollins2
1Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Insights
Optimizing nutrition for low-birth-weight (LBW) infants with short-bowel syndrome (SBS) and ostomy is difficult. A minority achieved enteral autonomy, with distal ostomies and better growth associated with success.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Nutritional Science
Background:
- Optimal nutrition is challenging for low-birth-weight (LBW) infants with short-bowel syndrome (SBS) and ostomy.
- Intestinal failure (IF) in these infants necessitates complex management strategies.
Purpose of the Study:
- To evaluate the clinical course of LBW infants with SBS and ostomy receiving enteral feeds.
- To identify characteristics associated with achieving enteral autonomy before ostomy reanastomosis.
- To assess short-term outcomes in this vulnerable population.
Main Methods:
- Retrospective analysis of 52 LBW neonates with IF due to SBS and ostomy (2012-2018).
- Clinical characteristics and outcomes were examined based on ostomy location and enteral feeding success.
- Comparison of outcomes between infants with jejunostomy, ileostomy, and colostomy.
Main Results:
- Among 52 infants, 14 (26.9%) achieved transient enteral autonomy, and 7 (13.5%) sustained it until reanastomosis.
- Jejunostomy infants were parenteral nutrition dependent (9/9), unlike ileostomy (22/40) and colostomy (0/3) infants (P=0.002).
- Enteral autonomy was linked to reduced cholestasis (P=0.038) and improved growth velocity (P=0.02).
Conclusions:
- A minority of LBW infants with SBS and ostomy achieve enteral autonomy pre-reanastomosis.
- Distal ostomy location (ileostomy/colostomy) and improved growth are associated with achieving enteral autonomy.
- Establishing enteral autonomy presents challenges but offers tangible benefits in a subset of these infants.
Background:
It is challenging to provide optimum nutrition in low-birth-weight (LBW) infants with short-bowel syndrome (SBS) and ostomy. This study aims to evaluate the clinical course of LBW infants with SBS and ostomy in response to enteral feeds, recognize characteristics associated with achievement of enteral autonomy prior to reanastomosis, and evaluate associated short-term outcomes.
Methods:
A retrospective analysis of 52 LBW neonates with intestinal failure (IF) caused by SBS and ostomy treated in a neonatal intensive care unit from 2012 to 2018 was performed. Clinical characteristics and short-term outcomes were studied in relation to the location of the ostomy and the success with enteral feeding achieved prior to reanastomosis.
Results:
Of the 52 infants with SBS, jejunostomy, ileostomy, and colostomy were present in 9, 40, and 3 infants, respectively. Fourteen (26.92%) infants achieved enteral autonomy transiently, and 7 (13.46%) sustained until reanastomosis. All 9 infants with jejunostomy were parenteral nutrition dependent, compared with 22 with ileostomy and none with colostomy (P = 0.002). Infants who achieved enteral autonomy showed lower incidence of cholestasis (P = 0.038) and better growth velocity (P = 0.02) prior to reanastomosis.
Conclusions:
A minority of LBW infants with SBS and ostomy achieved enteral autonomy prior to reanastomosis. Distal ostomy (ileostomy and colostomy), reduced cholestasis, and better growth were associated with achievement of enteral autonomy. Our report highlights the challenges in establishing enteral autonomy in LBW infants with IF and ostomy, and the feasibility of that approach in a minority of patients, with tangible benefits.
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