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Adaptation in short-bowel syndrome: reassessing old limits
A G Kurkchubasche1, M I Rowe, S D Smith
1Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, School of Medicine, PA 15213-2583.
Journal of Pediatric Surgery
|August 1, 1993
Summary
Infants with less than 10 cm of small intestine rarely achieve full enteral nutrition adaptation. Survival and adaptation rates improve with increased intestinal length, highlighting critical thresholds for nutritional outcomes in short bowel syndrome.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Severe short bowel syndrome (SBS) impacts infant survival and nutrition.
- Advances in intestinal transplantation necessitate understanding adaptation limits.
- Determining critical intestinal length for enteral autonomy is crucial.
Purpose of the Study:
- To identify the minimum intestinal length required for adaptation to full enteral nutrition in infants.
- To determine the time required for intestinal adaptation in infants with short bowel syndrome.
- To evaluate survival and adaptation outcomes based on initial intestinal length.
Main Methods:
- Retrospective review of 21 infants with < 50 cm of small intestine.
- Patients categorized into three groups based on intestinal length (<10 cm, 10-30 cm, 30-50 cm).
- Data collected on survival, adaptation incidence, time to adaptation, and mortality causes.
Main Results:
- Infants with < 10 cm intestinal length did not achieve enteral adaptation.
- Survival was 78% for patients with > 10 cm intestinal length.
- Adaptation occurred in 63% of survivors with 10-30 cm and 100% with 30-50 cm, taking 320 and 376 days respectively.
Conclusions:
- Intestinal length < 10 cm is insufficient for adaptation to full enteral nutrition.
- A threshold of > 10 cm small intestine is associated with improved survival and adaptation potential.
- Time to adaptation varies significantly, emphasizing the need for individualized management in short bowel syndrome.