Enteral autonomy in pediatric short bowel syndrome: predictive factors one year after diagnosis

Farokh R Demehri; Lauren Stephens; Emma Herrman; Brady West; Ann Mehringer; Meghan A Arnold; Pamela I Brown; Daniel H Teitelbaum

doi:10.1016/j.jpedsurg.2014.10.011

Enteral autonomy in pediatric short bowel syndrome: predictive factors one year after diagnosis

J Pediatr Surg. 2015 Jan;50(1):131-5. doi: 10.1016/j.jpedsurg.2014.10.011. Epub 2014 Oct 26.

Authors

Farokh R Demehri¹, Lauren Stephens¹, Emma Herrman¹, Brady West², Ann Mehringer¹, Meghan A Arnold¹, Pamela I Brown³, Daniel H Teitelbaum⁴

Affiliations

¹ Department of Surgery, Section of Pediatric Surgery, University of MI Health System, Ann Arbor, USA.
² Center for Statistical Consultation and Research, University of MI, Ann Arbor, USA.
³ Department of Pediatrics, Division of Pediatric Gastroenterology, University of MI Health System, Ann Arbor, USA.
⁴ Department of Surgery, Section of Pediatric Surgery, University of MI Health System, Ann Arbor, USA. Electronic address: dttlbm@umich.edu.

PMID: 25598109
DOI: 10.1016/j.jpedsurg.2014.10.011

Abstract

Purpose: This study examined predictors of achieving enteral autonomy among pediatric short bowel syndrome (SBS) patients remaining on parenteral nutrition (PN) beyond one year.

Methods: A retrospective single-institution study of 171 pediatric SBS patients (defined as ≥50% small bowel (SB) loss or ≥60 days of PN with onset before 6 weeks of age) was performed. Multivariate Cox proportional hazards analysis was conducted, with subgroup analysis of patients on PN for ≥1 year (n=59). Primary outcome was successful wean from PN.

Results: Over a follow-up of 4.1±4.8 years, 64.3% of children weaned from PN. Mortality was 15.2%. Presence of ≥10% expected SB length (hazard ratio [HR] 6.48, p=0.002) or an ileocecal valve (ICV; HR, 2.86, p<0.001) predicted PN weaning. Of those on PN ≥1 year, the wean rate was 50.8%, and ICV no longer predicted weaning (p=0.153). Predictors among those on PN ≥1 year were: ≥10% expected SB length (HR, 8.27, p=0.010), intestinal atresia (HR, 4.26, p=0.011), and necrotizing enterocolitis (NEC, HR, 2.84, p=0.025).

Conclusions: SBS children on PN ≥1 year continue to wean from PN, and those with ≥10% of predicted SB length, NEC, or atresia are more likely to do so. These findings may help direct management and advice for these challenging patients.

Keywords: Intestinal failure; Parenteral nutrition; Pediatric; Short bowel syndrome.

MeSH terms

Child
Child, Preschool
Female
Humans
Infant
Male
Multivariate Analysis
Parenteral Nutrition
Proportional Hazards Models
Retrospective Studies
Short Bowel Syndrome / mortality
Short Bowel Syndrome / therapy*