JPEN J Parenter Enteral Nutr. 2023 Dec 7. doi: 10.1002/jpen.2587. Online ahead of print.
ABSTRACT
BACKGROUND: Achievement of enteral autonomy (EA) is the ultimate treatment goal in pediatric intestinal failure. We aimed to assess predictors of EA in pediatric short bowel syndrome (SBS) and explore the impact of residual small bowel (SB) and large bowel (LB) length on EA.
METHODS: A retrospective cohort study was performed on infants <12 months (n=367, six centers) with SBS referred between 2010 and 2015. The cohort was stratified based on achievement of EA. Statistical testing completed using t test, Chi Square, Cox Proportional Hazards regression model and Kaplan-Meier analysis.
RESULTS: EA was achieved in 229 patients. In the multivariable analysis, percentage of residual LB (HR=1.02; 95% CI 1.01-1.02) and SB (HR= 1.01; 95% CI 1.01-1.02) length, presence of ICV (HR= 2.02; 95% CI 1.41-2.88), and not coming from a high-volume transplantation center (HR= 2.42; 95% CI 1.68-3.49) were positively associated with EA, while a negative association was seen with the presence of stoma at the time when shortest remnant was documented (HR= 0.72; 95% CI 0.52-1.00). EA achievement was significantly different between the anatomical subgroups (Log-rank test p<0.001) with EA rate of 80.4% in infants with ≥ 50% SB and LB (median time – 209 days); 62.5% with ≥ 50% SB and<50% LB (397 days); 58.3% with <50% SB and ≥ 50% LB (1192 days), 25.9% with < 50% SB and LB. NEC was not associated with a better achievement of EA (NEC vs. other etiologies; Log-rank test p = 0.33).
CONCLUSIONS: Overall 62% of infants with IF secondary to SBS achieved EA over a mean time of follow-up of 2.3 years. A colon length of >50% can compensate for the loss of small bowel (<50%) and account for similar EA rates as in children with residual SB>50%. This article is protected by copyright. All rights reserved.
PMID:38062898 | DOI:10.1002/jpen.2587
