Outcomes of intestinal failure--a comparison between children with short bowel and dysmotile intestine.
BACKGROUND
We investigated whether mortality, intestinal adaptation, and liver function differ between intestinal failure (IF) patients with either short bowel (SB) or bowel dysmotility (DM).


METHODS
Twenty-six consecutive patients with SB (n = 20) or DM (n = 6) treated between 2000 and 2007 were retrospectively assessed. Intestinal failure was defined as less than 25% of age-adjusted small intestinal length or dependence on parenteral nutrition (PN) more than 6 months.


RESULTS
Median age-adjusted small intestinal length (17% vs 45%) and gestational age (35 vs 40 weeks) were (P < .05) shorter, whereas proportion of the remaining colon (86% vs 0%) was (P < .05) higher in the SB group relative to the DM group. Overall survival was 92%. Median peak serum bilirubin (80 vs 25 micromol/L) and rate of cholestasis (11/20 vs 0/6) were higher (P < .05) in the SB group. Short bowel rather than DM as an etiology of IF predicted weaning off PN (RR, 39.3; 95% confidence interval [CI], 1.43-526; P < .01) and development of cholestasis (risk ration [RR], 18.3; 95% CI, 0.658-127; P < .05). Three SB children developed liver failure and two died, whereas neither of these occurred in the DM group.


CONCLUSIONS
Children with SB are more likely to wean off PN but more prone to cholestatic liver disease than those with DM as an etiology of IF.
Pakarinen
Mikko P
MP
Section of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Box 281, FIN-00029 HUS Helsinki, Finland. mikko.pakarinen@hus.fi
Koivusalo
Antti I
AI
Rintala
Risto J
RJ
D001663:Bilirubin / Q000097:blood; D002423:Cause of Death; D002675:Child, Preschool; D002779:Cholestasis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood / Q000453:epidemiology; D045823:Ileus / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery*; D008297:Male; D012778:Short Bowel Syndrome / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000706:statistics & numerical data
D001663:Bilirubin