title: Enteral autonomy in pediatric short bowel syndrome: predictive factors one year after diagnosis.
abstract: OBJECTIVE
  This study examined predictors of achieving enteral autonomy among pediatric short bowel syndrome (SBS) patients remaining on parenteral nutrition (PN) beyond one year.
  
  
  METHODS
  A retrospective single-institution study of 171 pediatric SBS patients (defined as ≥50% small bowel (SB) loss or ≥60 days of PN with onset before 6 weeks of age) was performed. Multivariate Cox proportional hazards analysis was conducted, with subgroup analysis of patients on PN for ≥1 year (n=59). Primary outcome was successful wean from PN.
  
  
  RESULTS
  Over a follow-up of 4.1±4.8 years, 64.3% of children weaned from PN. Mortality was 15.2%. Presence of ≥10% expected SB length (hazard ratio [HR] 6.48, p=0.002) or an ileocecal valve (ICV; HR, 2.86, p<0.001) predicted PN weaning. Of those on PN ≥1 year, the wean rate was 50.8%, and ICV no longer predicted weaning (p=0.153). Predictors among those on PN ≥1 year were: ≥10% expected SB length (HR, 8.27, p=0.010), intestinal atresia (HR, 4.26, p=0.011), and necrotizing enterocolitis (NEC, HR, 2.84, p=0.025).
  
  
  CONCLUSIONS
  SBS children on PN ≥1 year continue to wean from PN, and those with ≥10% of predicted SB length, NEC, or atresia are more likely to do so. These findings may help direct management and advice for these challenging patients.
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of MI Health System, Ann Arbor, USA.
authors.forename: Farokh R
authors.initials: FR
authors.lastname: Demehri
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of MI Health System, Ann Arbor, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Stephens
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of MI Health System, Ann Arbor, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Herrman
authors.affiliation: Center for Statistical Consultation and Research, University of MI, Ann Arbor, USA.
authors.forename: Brady
authors.initials: B
authors.lastname: West
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of MI Health System, Ann Arbor, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Mehringer
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of MI Health System, Ann Arbor, USA.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Arnold
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, University of MI Health System, Ann Arbor, USA.
authors.forename: Pamela I
authors.initials: PI
authors.lastname: Brown
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of MI Health System, Ann Arbor, USA. Electronic address: dttlbm@umich.edu.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010288:Parenteral Nutrition; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000401:mortality / Q000628:therapy*
keywords: Intestinal failure; Parenteral nutrition; Pediatric; Short bowel syndrome