title: Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome.
abstract: OBJECTIVE
  Necrotizing enterocolitis (NEC) remains one of the most common underlying diagnoses of short bowel syndrome (SBS) in children. The relationship between the etiology of SBS and ultimate enteral autonomy has not been well studied. This investigation sought to evaluate the rate of achievement of enteral autonomy in SBS patients with and without NEC.
  
  
  METHODS
  Following IRB approval, 109 patients (2002-2014) at a multidisciplinary intestinal rehabilitation program were reviewed. The primary outcome evaluated was achievement of enteral autonomy (i.e. fully weaning from parenteral nutrition). Patient demographics, primary diagnosis, residual small bowel length, percent expected small bowel length, median serum citrulline level, number of abdominal operations, status of the ileocecal valve (ICV), presence of ileostomy, liver function tests, and treatment for bacterial overgrowth were recorded for each patient.
  
  
  RESULTS
  Median age at PN onset was 0 weeks [IQR 0-0]. Median residual small bowel length was 33.5 cm [IQR 20-70]. NEC was present in 37 of 109 (33.9%) of patients. 45 patients (41%) achieved enteral autonomy after a median PN duration of 15.3 [IQR 7.2-38.4]months. Overall, 64.9% of patients with NEC achieved enteral autonomy compared to 29.2% of patients with a different primary diagnosis (p=0.001, Fig. 1). Patients with NEC remained more likely than those without NEC to achieve enteral autonomy after two (45.5% vs. 12.0%) and four (35.7% vs. 6.3%) years on PN (Fig. 1). Logistic regression analysis demonstrated the following parameters as independent predictors of enteral autonomy: diagnosis of NEC (p<0.002), median serum citrulline level (p<0.02), absence of a jejunostomy or ileostomy (p=0.013), and percent expected small bowel length (p=0.005).
  
  
  CONCLUSIONS
  Children with SBS because of NEC have a significantly higher likelihood of fully weaning from parenteral nutrition compared to children with other causes of SBS. Additionally, patients with NEC may attain enteral autonomy even after long durations of parenteral support.
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sparks
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Faraz A
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Fisher
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Brenna S
authors.initials: BS
authors.lastname: Fullerton
authors.affiliation: Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Hall
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Bram P
authors.initials: BP
authors.lastname: Raphael
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: tom.jaksic@childrens.harvard.edu.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010289:Parenteral Nutrition, Total; D011379:Prognosis; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000209:etiology* / Q000628:therapy; D013997:Time Factors
keywords: Enteral nutrition; Intestinal failure; NEC; Necrotizing enterocolitis; Parenteral nutrition; Short bowel syndrome