Teresa Capriati1, Daniela Giorgio1, Fabio Fusaro2, Manila Candusso3, Paolo Schingo4, Tamara Caldaro5, Francesca Laureti1, Domenica Elia1, Antonella Diamanti1. 1. Artificial Nutrition Unit, Ospedale Pediatrico Bambino Gesu, Roma, Italy. 2. Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy. 3. Department of Gastroenterology, Hepatolgy and Nutrition Unit, Ospedale Pediatrico Bambino Gesu, Rome, Italy. 4. Department of Imaging, Ospedale Pediatrico Bambino Gesu, Rome, Italy. 5. Department of Digestive surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Abstract
OBJECTIVES: The aim of this study was to ascertain predictors of survival, liver disease (LD), and enteral autonomy 48 months after resection in neonatal short bowel syndrome (SBS) patients with residual small bowel length (SBL) ≤40 cm. PATIENTS AND METHODS: Medical records of all SBS patients followed up between 1996 and 2016 were retrospectively reviewed. Survival rate, prevalence of LD, and of enteral autonomy were evaluated. RESULTS: Forty-seven patients were included, and 43 were still alive at the end of the study period, with cumulative 48-month survival of 91.5%. Twenty-one (45%) patients developed LD, all within the first 6 months. On the final follow-up visit, three (6%) patients were still jaundiced and progressed toward end-stage LD. LD prevalence was higher in patients with recurrent bloodstream infections (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.5-19.3). Of the 43 surviving patients, 22 (51%) had enteral autonomy 48 months after resection. The probability of weaning off parenteral nutrition (PN) was strongly correlated with the remaining SBL. CONCLUSION: Survival of patients who have undergone neonatal massive small bowel resection has improved in recent years. Multidisciplinary strategies can improve the course of LD, but not the probability of weaning off PN, which seems to be strongly dependent on the anatomical profile of residual bowel. Therefore, the primary surgical approach should be as conservative as possible to gain even small amounts of intestinal length, which may be crucial in promoting intestinal adaptation. Georg Thieme Verlag KG Stuttgart · New York.
OBJECTIVES: The aim of this study was to ascertain predictors of survival, liver disease (LD), and enteral autonomy 48 months after resection in neonatal short bowel syndrome (SBS) patients with residual small bowel length (SBL) ≤40 cm. PATIENTS AND METHODS: Medical records of all SBSpatients followed up between 1996 and 2016 were retrospectively reviewed. Survival rate, prevalence of LD, and of enteral autonomy were evaluated. RESULTS: Forty-seven patients were included, and 43 were still alive at the end of the study period, with cumulative 48-month survival of 91.5%. Twenty-one (45%) patients developed LD, all within the first 6 months. On the final follow-up visit, three (6%) patients were still jaundiced and progressed toward end-stage LD. LD prevalence was higher in patients with recurrent bloodstream infections (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.5-19.3). Of the 43 surviving patients, 22 (51%) had enteral autonomy 48 months after resection. The probability of weaning off parenteral nutrition (PN) was strongly correlated with the remaining SBL. CONCLUSION: Survival of patients who have undergone neonatal massive small bowel resection has improved in recent years. Multidisciplinary strategies can improve the course of LD, but not the probability of weaning off PN, which seems to be strongly dependent on the anatomical profile of residual bowel. Therefore, the primary surgical approach should be as conservative as possible to gain even small amounts of intestinal length, which may be crucial in promoting intestinal adaptation. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Antonella Diamanti; Teresa Capriati; Paolo Gandullia; Grazia Di Leo; Antonella Lezo; Laura Lacitignola; Maria Immacolata Spagnuolo; Simona Gatti; Lorenzo D'Antiga; Giovanna Verlato; Paola Roggero; Sergio Amarri; Maria Elisabetta Baldassarre; Francesco Cirillo; Domenica Elia; Renata Boldrini; Angelo Campanozzi; Carlo Catassi; Marina Aloi; Claudio Romano; Manila Candusso; Nicola Cecchi; Tommaso Bellini; Elaine Tyndall; Fabio Fusaro; Tamara Caldaro; Daniele Alberti; Piergiorgio Gamba; Mario Lima; Pietro Bagolan; Jean De Ville de Goyet; Luigi Dall'Oglio; Marco Spada; Francesca Grandi Journal: Nutrients Date: 2017-11-05 Impact factor: 5.717