Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: A 25-year experience

Rubén E. Quirós-Tejeira, Marvin E. Ament, Laurie Reyen, Faye Herzog, Michelle Merjanian, Nancy Olivares-Serrano, Jorge H. Vargas

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

Objective To analyze the outcome of children with short bowel syndrome (SBS) who required long-term parenteral nutrition (PN). Study design Retrospective analysis of children (n=78) with SBS who required PN >3 months from 1975 to 2000. Statistics: univariate analysis, Kaplan-Meier method, and Cox proportional regression model were used. Results We identified 78 patients. Survival was better with small bowel length (SBL) >38 cm, intact ileocecal valve (ICV), intact colon, takedown surgery after ostomy (all P < .01), and primary anastomosis (P < .001). PN-associated early persistent cholestatic jaundice (P < .001) and SBL of <15cm (P < .01) were associated with a higher mortality. Intestinal adaptation was less likely if SBL <15 cm (P < .05), ICV was removed, colonic resection was done (both P < .001), >50% of colon was resected (P < .05), and primary anastomosis could not be accomplished (P < .01). Survival was 73% (57), and 77% (44) of survivors had intestinal adaptation. Conclusions SBL, intact ICV, intestinal continuity, and preservation of the colon are important factors for survival and adaptation. Adaptation usually occurred within the first 3 years. Need for long-term PN does not preclude achieving productive adulthood. Patients with ICV even with <15 cm of SBL and patients with SBL >15 cm without ICV have a chance of intestinal adaptation.

Original languageEnglish (US)
Pages (from-to)157-163
Number of pages7
JournalJournal of Pediatrics
Volume145
Issue number2
DOIs
StatePublished - Aug 1 2004

Fingerprint

Ileocecal Valve
Short Bowel Syndrome
Nutritional Support
Parenteral Nutrition
Colon
Ostomy
Kaplan-Meier Estimate
Retrospective Studies
Survival

Keywords

  • CVC
  • Central venous catheter
  • ESLD
  • End-stage liver disease
  • ICV
  • Ileocecal valve
  • NEC
  • Necrotizing enterocolitis
  • PN
  • Parenteral nutrition
  • SBL
  • SBS
  • SSB
  • Short bowel syndrome
  • Short small bowel
  • Small bowel length
  • USSB
  • Ultra short small bowel
  • VSSB

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome : A 25-year experience. / Quirós-Tejeira, Rubén E.; Ament, Marvin E.; Reyen, Laurie; Herzog, Faye; Merjanian, Michelle; Olivares-Serrano, Nancy; Vargas, Jorge H.

In: Journal of Pediatrics, Vol. 145, No. 2, 01.08.2004, p. 157-163.

Research output: Contribution to journalArticle

Quirós-Tejeira, Rubén E. ; Ament, Marvin E. ; Reyen, Laurie ; Herzog, Faye ; Merjanian, Michelle ; Olivares-Serrano, Nancy ; Vargas, Jorge H. / Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome : A 25-year experience. In: Journal of Pediatrics. 2004 ; Vol. 145, No. 2. pp. 157-163.
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title = "Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: A 25-year experience",
abstract = "Objective To analyze the outcome of children with short bowel syndrome (SBS) who required long-term parenteral nutrition (PN). Study design Retrospective analysis of children (n=78) with SBS who required PN >3 months from 1975 to 2000. Statistics: univariate analysis, Kaplan-Meier method, and Cox proportional regression model were used. Results We identified 78 patients. Survival was better with small bowel length (SBL) >38 cm, intact ileocecal valve (ICV), intact colon, takedown surgery after ostomy (all P < .01), and primary anastomosis (P < .001). PN-associated early persistent cholestatic jaundice (P < .001) and SBL of <15cm (P < .01) were associated with a higher mortality. Intestinal adaptation was less likely if SBL <15 cm (P < .05), ICV was removed, colonic resection was done (both P < .001), >50{\%} of colon was resected (P < .05), and primary anastomosis could not be accomplished (P < .01). Survival was 73{\%} (57), and 77{\%} (44) of survivors had intestinal adaptation. Conclusions SBL, intact ICV, intestinal continuity, and preservation of the colon are important factors for survival and adaptation. Adaptation usually occurred within the first 3 years. Need for long-term PN does not preclude achieving productive adulthood. Patients with ICV even with <15 cm of SBL and patients with SBL >15 cm without ICV have a chance of intestinal adaptation.",
keywords = "CVC, Central venous catheter, ESLD, End-stage liver disease, ICV, Ileocecal valve, NEC, Necrotizing enterocolitis, PN, Parenteral nutrition, SBL, SBS, SSB, Short bowel syndrome, Short small bowel, Small bowel length, USSB, Ultra short small bowel, VSSB",
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T1 - Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome

T2 - A 25-year experience

AU - Quirós-Tejeira, Rubén E.

AU - Ament, Marvin E.

AU - Reyen, Laurie

AU - Herzog, Faye

AU - Merjanian, Michelle

AU - Olivares-Serrano, Nancy

AU - Vargas, Jorge H.

PY - 2004/8/1

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N2 - Objective To analyze the outcome of children with short bowel syndrome (SBS) who required long-term parenteral nutrition (PN). Study design Retrospective analysis of children (n=78) with SBS who required PN >3 months from 1975 to 2000. Statistics: univariate analysis, Kaplan-Meier method, and Cox proportional regression model were used. Results We identified 78 patients. Survival was better with small bowel length (SBL) >38 cm, intact ileocecal valve (ICV), intact colon, takedown surgery after ostomy (all P < .01), and primary anastomosis (P < .001). PN-associated early persistent cholestatic jaundice (P < .001) and SBL of <15cm (P < .01) were associated with a higher mortality. Intestinal adaptation was less likely if SBL <15 cm (P < .05), ICV was removed, colonic resection was done (both P < .001), >50% of colon was resected (P < .05), and primary anastomosis could not be accomplished (P < .01). Survival was 73% (57), and 77% (44) of survivors had intestinal adaptation. Conclusions SBL, intact ICV, intestinal continuity, and preservation of the colon are important factors for survival and adaptation. Adaptation usually occurred within the first 3 years. Need for long-term PN does not preclude achieving productive adulthood. Patients with ICV even with <15 cm of SBL and patients with SBL >15 cm without ICV have a chance of intestinal adaptation.

AB - Objective To analyze the outcome of children with short bowel syndrome (SBS) who required long-term parenteral nutrition (PN). Study design Retrospective analysis of children (n=78) with SBS who required PN >3 months from 1975 to 2000. Statistics: univariate analysis, Kaplan-Meier method, and Cox proportional regression model were used. Results We identified 78 patients. Survival was better with small bowel length (SBL) >38 cm, intact ileocecal valve (ICV), intact colon, takedown surgery after ostomy (all P < .01), and primary anastomosis (P < .001). PN-associated early persistent cholestatic jaundice (P < .001) and SBL of <15cm (P < .01) were associated with a higher mortality. Intestinal adaptation was less likely if SBL <15 cm (P < .05), ICV was removed, colonic resection was done (both P < .001), >50% of colon was resected (P < .05), and primary anastomosis could not be accomplished (P < .01). Survival was 73% (57), and 77% (44) of survivors had intestinal adaptation. Conclusions SBL, intact ICV, intestinal continuity, and preservation of the colon are important factors for survival and adaptation. Adaptation usually occurred within the first 3 years. Need for long-term PN does not preclude achieving productive adulthood. Patients with ICV even with <15 cm of SBL and patients with SBL >15 cm without ICV have a chance of intestinal adaptation.

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KW - SBS

KW - SSB

KW - Short bowel syndrome

KW - Short small bowel

KW - Small bowel length

KW - USSB

KW - Ultra short small bowel

KW - VSSB

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