Pediatric short bowel syndrome: redefining predictors of success.
OBJECTIVE
To determine predictors of survival and of weaning off parenteral nutrition (PN) in pediatric short bowel syndrome (SBS) patients.


BACKGROUND
Pediatric SBS carries extensive morbidity and high mortality, but factors believed to predict survival or weaning from PN have been based on limited studies. This study reviews outcomes of a large number of SBS infants and identifies predictors of success.


METHODS
Multivariate Cox proportional hazards analysis was conducted on 80 pediatric SBS patients. Primary outcome was survival; secondary outcome was ability to wean off PN. Nonsignificant covariates were eliminated. P < 0.05 was considered significant.


RESULTS
Over a mean of 5.1 years of follow-up, survival was 58 of 80 (72.5%) and 51 weaned off PN (63.8%). Cholestasis (conjugated bilirubin > or =2.5 mg/dL) was the strongest predictor of mortality (relative risk [RR] 22.7, P = 0.005). Although absolute small bowel length was only slightly predictive, percentage of normal bowel length (for a given infant's gestational age) was strongly predictive of mortality (if <10% of normal length, RR of death was 5.7, P = 0.003) and of weaning PN (if > or =10% of normal, RR of weaning PN was 11.8, P = 0.001). Presence of the ileocecal valve (ICV) also strongly predicted weaning PN (RR 3.9, P < 0.0005); however, ICV was not predictive of survival.


CONCLUSIONS
Cholestasis and age-adjusted small bowel length are the major predictors of mortality in pediatric SBS. Age-adjusted small bowel length and ICV are the major predictors of weaning from PN. These data permit better prediction of outcomes of pediatric SBS, which may help to direct future management of these challenging patients.
Spencer
Ariel U
AU
Departments of Surgery, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, MI 48109, USA.
Neaga
Andreea
A
West
Brady
B
Safran
Jared
J
Brown
Pamela
P
Btaiche
Imad
I
Kuzma-O'Reilly
Barbara
B
Teitelbaum
Daniel H
DH
D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D002779:Cholestasis / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009929:Organ Size / Q000187:drug effects; D010288:Parenteral Nutrition / Q000009:adverse effects; D011379:Prognosis; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis