Predicting time to full enteral nutrition in children after significant bowel resection.
OBJECTIVE
Parenteral nutrition (PN) contributes to considerable morbidity in children after significant bowel resection. This study evaluates the utility of clinical variables in predicting time to independence from PN.


METHODS
After IRB approval, a retrospective review (1999-2012) of 71 children who were on PN for >6weeks after intestinal resection and successfully weaned was performed. Clinical characteristics were evaluated to determine the relationship to time to full enteral nutrition. P-values<0.05 were significant.


RESULTS
Most children had necrotizing enterocolitis (56%), intestinal atresia (20%), or gastroschisis (11%) with a median small bowel length of 55cm (IQR, 35-92cm). The duration of PN was independent of the etiology of intestinal loss, presence of the ileocecal valve or colon, or location of anastomosis, but was strongly associated with small bowel length (<0.01) and percent of expected small bowel based on gestational age (GA) (median 50%, <0.01). In general, children who had 25-50% of their small bowel were dependent on PN for at least 2years compared to approximately 1year for those with 51-75%.


CONCLUSIONS
The duration of PN dependence in children after major bowel resection is best predicted by remaining small bowel length and can be estimated using a linear regression model.


METHODS
2b.
Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
Jessica
J
Gonzalez-Hernandez
Office of the Chief Quality Officer, Baylor Scott and White Health, Dallas, TX, USA.
Purvi
P
Prajapati
Office of the Chief Quality Officer, Baylor Scott and White Health, Dallas, TX, USA.
Gerald
G
Ogola
Division of Pediatric Gastroenterology, University of Texas Southwestern/Children's Health, Dallas, TX, USA.
Nandini
N
Channabasappa
Division of Pediatric Gastroenterology, University of Texas Southwestern/Children's Health, Dallas, TX, USA.
Barbara
B
Drews
Division of Pediatric Surgery, University of Texas Southwestern/Children's Health, Dallas, TX, USA. Electronic address: hannah.piper@childrens.com.
Hannah G
HG
Piper
D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D020345:Enterocolitis, Necrotizing / Q000601:surgery; D005260:Female; D020139:Gastroschisis / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery*; D016014:Linear Models; D008297:Male; D010288:Parenteral Nutrition / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
Intestinal failure; Parenteral nutrition; Pediatrics; Small bowel length