The ratio of remaining to expected small bowel length predicts enteral autonomy in pediatric patients with short bowel syndrome

Abstract

Background: Pediatric patients with short bowel syndrome (SBS) often require long-term parenteral nutrition and intravenous fluid support (PN) until enteral autonomy (EA). However, long-term PN accounts for many complications. We aimed to investigate the outcome and predictors of EA in these patients.

Material and methods: This retrospective observational study was conducted in Children's Medical Center, Chang Gung Memorial Hospital, a tertiary hospital in Northern Taiwan. Twenty-four patients afflicted with short bowel syndrome between 2002 and 2021 were included. Demographics, operation results, follow-up status, complications, and outcomes were reviewed.

Results: Among the 24 patients, 14 were males (58%). The median age at bowel resection was 3 days (IQR, 1.3-28.8 days). The most common etiologies were total/subtotal intestinal aganglionosis (TIA) (N = 6) and malrotation with midgut volvulus (N = 6). The median length of the residual small intestine was 25 cm (IQR, 7.8-71.3 cm). Ten (41.7%) had preserved ileocecal valve, and 14 (58.3%) had colon-in-continuity. Intestinal failure-associated liver disease (IFALD) occurred in 14 patients (58.3%), but none had advanced disease. Seven patients (29.2%) achieved enteral autonomy after 10.1 ± 7.3 months. Five patients (21%) expired due to sepsis. Logistic regression and Kaplan-Meier analysis showed the predictors of enteral autonomy were remaining-to-expected small bowel length ratio >25% and the absence of IFALD.

Conclusions: In this pediatric short bowel syndrome study, enteral autonomy was achieved in 29% after a mean PN duration of 10 months. The remaining-to-expected small bowel length ratio at bowel resection was the most critical predictor of enteral autonomy.

Keywords: Catheter-related bloodstream infection; Enteral autonomy; Intestinal failure-associated liver disease; Short bowel syndrome.