title: Growth and nutritional status in infants with short-bowel syndrome after the serial transverse enteroplasty procedure.
abstract: OBJECTIVE
  The aim of this study was to describe the long-term nutritional outcomes of 4 patients with short bowel syndrome (SBS) who underwent a newly described bowel-lengthening procedure, the serial transverse enteroplasty (STEP) procedure.
  
  
  METHODS
  We performed a retrospective review of the medical records of 4 children who underwent STEP at 1 center. The primary outcome measure was the percentage of total dietary energy received by the enteral route before and after STEP. Other outcome measures were weight and height Z scores and body composition, as measured by arm anthropometric values.
  
  
  RESULTS
  Four children with SBS were identified, all of whom had been dependent on parenteral nutrition since birth. The mean preoperative follow-up period was 234 days (range, 63-502 days), and the mean postoperative follow-up period was 362 days (range, 252-493 days). By using model-based mean estimates, the mean enteral nutrition intake was 48% preoperatively vs 62% postoperatively (P = .02). The model mean weight for age Z score increased by .7 SDs postoperatively (P = .01), and the model mean weight for height increased by .6 SDs (P < .0001). The percent standard mid-upper-arm circumference increased by 13.1% postoperatively (P = .03), and the percent standard triceps skinfold increased by 24.5% postoperatively (P < .0001).
  
  
  CONCLUSIONS
  The STEP procedure was associated with improved growth and body composition among 4 children with SBS in the face of a decreasing need for parenteral nutrition. Among patients with refractory SBS and dilated small intestine, the STEP procedure is associated with improved clinical and nutritional outcomes in the first year after surgery.
authors.affiliation: Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts 02115, USA. christopher.duggan@childrens.harvard.edu
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Hannah
authors.initials: H
authors.lastname: Piper
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Javid
authors.forename: Clarissa
authors.initials: C
authors.lastname: Valim
authors.forename: Sharon
authors.initials: S
authors.lastname: Collier
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome