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Predicting the duration of dependence on parenteral nutrition after neonatal intestinal resection
J M Sondheimer1, M Cadnapaphornchai, M Sontag
1University of Colorado Health Sciences Center, Department of Pediatrics, Denver, USA.
Insights
Predicting parenteral nutrition (PN) duration in infants with short bowel syndrome is possible using residual small bowel length and enteral feeding tolerance. This aids in early intervention for neonatal surgical patients.
Area of Science:
- Pediatric Surgery
- Neonatal Nutrition
- Gastroenterology
Background:
- Neonatal short bowel syndrome often necessitates long-term parenteral nutrition (PN).
- Predicting the duration of PN dependence is crucial for patient management and resource allocation.
Purpose of the Study:
- To identify clinical and physical factors predicting PN dependence duration in infants post-neonatal small intestine resection.
- To develop a predictive model for PN duration in this vulnerable population.
Main Methods:
- Retrospective review of 44 neonatal patients dependent on PN for ≥3 months post-small bowel resection.
- Cox Proportional Hazard model used to analyze patient variables impacting PN duration.
Main Results:
- Residual small bowel length and enteral energy intake percentage at 12 weeks were significant predictors of PN duration.
- Gestational age, ileocecal valve presence, and cholestasis were not significant predictors.
- A formula was generated using the Cox model to estimate PN dependence duration.
Conclusions:
- PN dependence duration in neonatal short bowel syndrome can be predicted early.
- Key predictors include post-surgical small bowel length and enteral feeding tolerance.
Objective:
To determine whether there are clinical or physical factors that could be used to predict the duration of dependence on parenteral nutrition (PN) in infants who have undergone resection of small intestine in the neonatal period.
Study Design:
Medical records of 44 patients who had small intestinal resection as neonates from 1985 to 1996 and who were dependent on PN for at least 3 months were reviewed. Statistical evaluation of patient variables and their impact on duration of dependence on PN were determined by using the Cox Proportional Hazard model.
Results:
Twenty-seven patients became independent of PN before the age of 36 months. Seven patients between 40 and 129 months of age are permanently dependent on PN. Outcome could not be determined in 10 patients, four of whom died of hepatic failure while still receiving PN and six of whom are still receiving PN but are younger than 36 months of age. Small bowel length after initial surgery and the percent of daily energy intake received by the enteral route at 12 weeks' adjusted age were significantly related to the duration of dependence on PN. Gestational age, presence of the ileocecal valve, and development of cholestasis were not significantly related. With the use of the Cox Proportional Hazards survival model, a formula was generated to allow estimation of the duration of dependence on PN.
Conclusions:
The duration of dependence on PN can be predicted at an early age in neonatal short bowel syndrome by using two patient variables: the length of residual small bowel after initial surgery and the percent of daily energy intake tolerated through the enteral route.
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