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Long-term outcomes of various pediatric short bowel syndrome in China
Tian Zhang1,2,3, Haixia Feng4,2,3, Yi Cao4,2,3
1Department of Pediatric Surgery, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Pediatric short bowel syndrome (SBS) patients show good long-term survival and can achieve enteral autonomy. Classifications like age of onset, parenteral nutrition (PN) duration, and anatomy don't affect overall mortality, but prolonged PN increases infection risk.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Rehabilitation
- Surgical Outcomes
Background:
- Short Bowel Syndrome (SBS) is a complex condition requiring specialized intestinal rehabilitation.
- Long-term outcomes in pediatric SBS vary significantly based on etiology and management.
- Understanding factors influencing survival and complications is crucial for improving patient care.
Purpose of the Study:
- To analyze the long-term outcomes of pediatric patients with Short Bowel Syndrome (SBS).
- To evaluate the impact of disease onset age, parenteral nutrition (PN) duration, and anatomical types on SBS outcomes.
- To identify risk factors for complications and mortality in a Chinese pediatric SBS cohort.
Main Methods:
- Retrospective analysis of 157 pediatric SBS patients from October 1988 to July 2019.
- Outcomes assessed based on age of onset, PN duration, and small bowel anatomy.
- Comparison of clinical characteristics, including PN dependence, IFALD, CRBI, and mortality.
Main Results:
- The primary etiologies for SBS were intestinal atresia, NEC, and volvulus.
- Overall survival rate was 84.7%, with infection and liver failure as main causes of death.
- Prolonged PN duration (>90 days) correlated with increased Catheter-Related Bloodstream Infections (CRBI) and was more common in older children.
- Patients with intestinal continuity had lower CRBI rates.
Conclusions:
- Pediatric SBS patients can achieve favorable long-term survival and enteral autonomy.
- Age of onset, PN duration, and bowel anatomy do not significantly impact overall SBS mortality.
- Prolonged PN duration is associated with increased CRBI incidence, highlighting the importance of optimizing PN management.
Purpose:
The goal of this study was to analyze long-term outcome of various pediatric short bowel syndrome (SBS) at an intestinal rehabilitation center in China.
Methods:
One hundred and fifty-seven children with SBS were enrolled in this study from October 1988 to July 2019. Their long-term follow-up outcome was analyzed according to the age of disease onset, parenteral nutrition (PN) duration, and anatomic types of short bowel, respectively. The clinical characteristics, which included demographics, the length of residual small bowel, PN duration, PN dependence, SBS-related complications such as IF-related liver disease (IFALD), catheter-related bloodstream infection (CRBI), and mortality were compared among the groups.
Results:
The main etiology for SBS were intestinal atresia, NEC, and volvulus. Five of 157 patients did not wean off PN. The incidence of IFALD and CRBI was 24.2 and 22.3%, respectively. Sixteen cases died because of infection and liver failure and eight patients lost to follow-up. The survival rate of the 157 patients was 84.7%. PN duration was longer in the infants and children group (284 ± 457 d vs. 110 ± 64 d, P = 0.021; R = 0.264, P = 0.001) and more patients did not wean off PN than in the neonates group (11.6% vs. 0, P = 0.001; R = 0.295, P < 0.001). Patients with PN with a duration of longer than 90 days had more CRBIs (30.6%, P = 0.025; R = 0.236, P = 0.003). Additionally, the rate of CRBI was higher in patients with stoma (30.0%, P = 0.032). There was no difference in mortality among the groups. In five PN dependence patients, none was SBS onset in neonates.
Conclusion:
Pediatric patients with SBS could achieve favorable long-term survival and enteral autonomy. Different standards of SBS classification such as the age of disease onset, PN duration, and anatomic types of short bowel did not impact the overall mortality of pediatric SBS. Prolonged PN duration positively correlated with the age of disease onset and the incidence of CRBI. Patients with the complete continuity of intestinal tract suffered less from CRBI.
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