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 <15 cm (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.
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 <15 cm (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.
Authors: Debora Duro; Leslie A Kalish; Patrick Johnston; Tom Jaksic; Maggie McCarthy; Cami Martin; James C Y Dunn; Mary Brandt; Kerilyn K Nobuhara; Karl G Sylvester; R Lawrence Moss; Christopher Duggan Journal: J Pediatr Date: 2010-05-06 Impact factor: 4.406
Authors: Faraz A Khan; Robert H Squires; Heather J Litman; Jane Balint; Beth A Carter; Jeremy G Fisher; Simon P Horslen; Tom Jaksic; Samuel Kocoshis; J Andres Martinez; David Mercer; Susan Rhee; Jeffrey A Rudolph; Jason Soden; Debra Sudan; Riccardo A Superina; Daniel H Teitelbaum; Robert Venick; Paul W Wales; Christopher Duggan Journal: J Pediatr Date: 2015-04-25 Impact factor: 4.406
Authors: Faraz A Khan; Paul D Mitchell; Jeremy G Fisher; Eric A Sparks; Tom Jaksic; Christopher Duggan; Daniel H Teitelbaum; Biren P Modi Journal: J Pediatr Surg Date: 2014-11-14 Impact factor: 2.545