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Improved survival in very short small bowel of infancy with use of long-term parenteral nutrition
Insights
Home parenteral nutrition significantly improved survival rates for children with very short small bowel syndrome. This advancement allows for normal growth and development, even with minimal remaining bowel length.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Neonatal Nutrition
Background:
- Short bowel syndrome (SBS) presents a significant challenge in pediatric care, historically associated with poor outcomes.
- Advances in medical management and nutritional support are crucial for improving the prognosis of SBS.
Purpose of the Study:
- To evaluate the efficacy of home parenteral nutrition (HPN) in improving survival and outcomes for infants with extremely short small bowel.
- To compare current survival rates with historical data for SBS patients.
Main Methods:
- Retrospective analysis of 13 children with jejunoileum length ≤38 cm treated with HPN between 1977 and 1984.
- Comparison of survival data with a historical cohort of SBS patients diagnosed before 1972.
- Assessment of growth, development, and nutritional independence in the HPN cohort.
Main Results:
- Survival rate in the HPN group was 69% (9/13), a significant improvement compared to the historical 23% (7/30).
- Five children achieved normal growth and development after discontinuing HPN.
- Normal growth was observed in all four children still on HPN, with three showing normal development.
Conclusions:
- Home parenteral nutrition has dramatically improved survival rates for infants with very short small bowel syndrome.
- Nutritional and developmental outcomes are favorable, with potential for discontinuation of HPN and normal growth even with minimal bowel length.
Abstract:
Thirteen children with very short small bowel (less than or equal to 38 cm jejunoileum) beginning in the first month of life were enrolled in a home parenteral nutrition program between 1977 and 1984. Their survival is compared with the collective reported experience with short bowel syndrome before 1972: nine (69%) of 13 have survived, compared with seven (23%) of 30 previously. Five discontinued parenteral nutrition after periods of 4 to 32 months of therapy, and have normal growth and development. Two still receive partial (50% and 60%) parenteral nutrition after 9 and 55 months, respectively, and two still receive total parenteral nutrition after 66 and 68 months of therapy, respectively; all four infants have grown normally, and three are developmentally normal. In the combined categories of 15 to 38 cm jejunoileum without the ileocecal valve and less than 15 cm jejunoileum with and without the ileocecal valve, seven (70%) of 10 have survived, compared with none (0%) of 16 before 1972; three of these discontinued parenteral nutrition. Ultimate survival with normal growth without parenteral nutrition is now possible with as little as 11 cm jejunoileum with an intact ileocecal valve and as little as 25 cm jejunoileum without an ileocecal valve.