Neonatal short bowel syndrome

Autor: Loreto Lecce, Paul W. Wales, Aideen M. Moore, Nicole de Silva, Amarpreet Sandhu, Jae H. Kim
Rok vydání: 2005
Předmět:
Zdroj: Journal of Pediatric Surgery. 40:755-762
ISSN: 0022-3468
DOI: 10.1016/j.jpedsurg.2005.01.037
Popis: Background To date, our knowledge of morbidity and mortality in neonatal short bowel syndrome (SBS) is based on individual case series. Shortcomings of the published literature include long patient recruitment time, selection bias, variable SBS definitions, failure to account for gestational age, and incomplete follow-up. By applying more rigorous methodology, our aim was to determine outcomes of SBS neonates compared with a control group of neonates without SBS. Methods A cohort study of all neonates with abdominal pathology requiring laparotomy between January 1, 1997, and December 31, 1998, with observation through July 1, 2001. Short bowel syndrome was defined as patients requiring parenteral nutrition for more than 42 days or residual small bowel length of less than 25% predicted by gestational age. Student's t test, Mann-Whitney U test, and χ 2 were used where appropriate. Kaplan-Meier curves were used to determine cumulative survival. Covariates important in the development of SBS were examined using forward step-wise logistic regression. Results There were 175 patients (with SBS=40, without SBS=135) with a mean gestational age of 30.7 ± 4.6 weeks vs 35.9 ± 4.8 weeks, respectively ( P P = .001). Most of the deaths were caused by liver failure or sepsis and occurred within 1 year from the date of surgery. Presence of an ileostomy (exp(B) = 12.29; P P Conclusion This cohort study clearly illustrates the tremendous morbidity experienced by infants with SBS relative to other surgical neonates. Accurate estimates of the morbidity associated with SBS enables clinicians to appropriately counsel parents, allocate resources and initiate therapeutic trials.
Databáze: OpenAIRE
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