title: Necrotizing Enterocolitis and Central Line Associated Blood Stream Infection Are Predictors of Growth Outcomes in Infants with Short Bowel Syndrome.
abstract: OBJECTIVE
  To describe the natural history of growth patterns and nutritional support in a cohort of infants with short bowel syndrome (SBS), and to characterize risk factors for suboptimal growth.
  
  
  METHODS
  A retrospective chart review of 51 infants with SBS followed by our intestinal rehabilitation program. Weight and length data were converted to age, sex, and gestational age-standardized weight-for-age z-scores (WAZ) and length-for-age z-scores (LAZ).
  
  
  RESULTS
  Median (IQR) age at enrollment was 8.3 (0.9-14.6) weeks, and follow-up duration was 10 (8-13) months, including both inpatient and outpatient visits. Both WAZ and LAZ followed a U-shaped curve, with median for newborns (WAZ = -0.28; LAZ = -0.41), a nadir at age 6 months (-2.38 and -2.18), and near recovery by age 1 year (-0.72 and -0.76). Using multivariable regression analysis, diagnosis of necrotizing enterocolitis was independently associated with significant decrements of WAZ (-0.76 ± 0.32; P = .02) and LAZ (-1.24 ± 0.32; P = .0001). ≥ 2 central line-associated bloodstream infections was also independently associated with decreases in WAZ (-0.95 ± 0.33; P = .004) and LAZ (-0.86 ± 0.32; P = .007).
  
  
  CONCLUSIONS
  In a cohort of infants with SBS, we observed a unique pattern of somatic growth, with concomitant deceleration of both WAZ and LAZ and near recovery by 1 year. Inflammatory conditions (necrotizing enterocolitis and central line-associated bloodstream infections) represent potentially modifiable risk factors for suboptimal somatic growth.
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Harvard Medical School, Boston, MA; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: bram.raphael@childrens.harvard.edu.
authors.forename: Bram P
authors.initials: BP
authors.lastname: Raphael
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Mitchell
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Darryl
authors.initials: D
authors.lastname: Finkton
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Hongyu
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Harvard Medical School, Boston, MA; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
mesh_terms: D016470:Bacteremia / Q000150:complications*; D001827:Body Height; D001835:Body Weight; D055499:Catheter-Related Infections / Q000150:complications*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002149:Energy Intake; D020345:Enterocolitis, Necrotizing / Q000150:complications*; D005260:Female; D006130:Growth Disorders / Q000209:etiology*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications*
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