Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: a 25-year experience.
OBJECTIVE
To analyze the outcome of children with short bowel syndrome (SBS) who required long-term parenteral nutrition (PN).


METHODS
Retrospective analysis of children (n=78) with SBS who required PN >3 months from 1975 to 2000.


METHODS
univariate analysis, Kaplan-Meier method, and Cox proportional regression model were used.


RESULTS
We identified 78 patients. Survival was better with small bowel length (SBL) >38 cm, intact ileocecal valve (ICV), intact colon, takedown surgery after ostomy (all P <.01), and primary anastomosis (P <.001). PN-associated early persistent cholestatic jaundice (P <.001) and SBL of <15 cm (P <.01) were associated with a higher mortality. Intestinal adaptation was less likely if SBL <15 cm (P <.05), ICV was removed, colonic resection was done (both P <.001), >50% of colon was resected (P <.05), and primary anastomosis could not be accomplished (P <.01). Survival was 73% (57), and 77% (44) of survivors had intestinal adaptation.


CONCLUSIONS
SBL, intact ICV, intestinal continuity, and preservation of the colon are important factors for survival and adaptation. Adaptation usually occurred within the first 3 years. Need for long-term PN does not preclude achieving productive adulthood. Patients with ICV even with <15 cm of SBL and patients with SBL >15 cm without ICV have a chance of intestinal adaptation.
Division of Gastroenterology and Nutrition, UCLA Medical Center, Los Angeles, California, USA. rquiros@bcm.tmc.edu
Rubén E
RE
Quirós-Tejeira
Marvin E
ME
Ament
Laurie
L
Reyen
Faye
F
Herzog
Michelle
M
Merjanian
Nancy
N
Olivares-Serrano
Jorge H
JH
Vargas
D000222:Adaptation, Physiological; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000628:therapy*; D016019:Survival Analysis; D013997:Time Factors