Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome
| Autor: | Eric A. Sparks, Christopher Duggan, Tom Jaksic, Jeremy G. Fisher, Brenna S. Fullerton, Faraz A. Khan, Amber M. Hall, Biren P. Modi, Bram P. Raphael |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Short Bowel Syndrome medicine.medical_specialty Time Factors Enteral administration Article 03 medical and health sciences Enteral Nutrition 0302 clinical medicine Enterocolitis Necrotizing 030225 pediatrics medicine Humans Intensive care medicine Retrospective Studies Enterocolitis business.industry Infant Newborn Infant Retrospective cohort study General Medicine Prognosis medicine.disease Short bowel syndrome digestive system diseases Logistic Models Parenteral nutrition Pediatrics Perinatology and Child Health Necrotizing enterocolitis Etiology Female Parenteral Nutrition Total 030211 gastroenterology & hepatology Surgery Liver function medicine.symptom business Follow-Up Studies |
| Zdroj: | Journal of Pediatric Surgery. 51:92-95 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2015.10.023 |
| Popis: | Necrotizing enterocolitis (NEC) remains one of the most common underlying diagnoses of short bowel syndrome (SBS) in children. The relationship between the etiology of SBS and ultimate enteral autonomy has not been well studied. This investigation sought to evaluate the rate of achievement of enteral autonomy in SBS patients with and without NEC.Following IRB approval, 109 patients (2002-2014) at a multidisciplinary intestinal rehabilitation program were reviewed. The primary outcome evaluated was achievement of enteral autonomy (i.e. fully weaning from parenteral nutrition). Patient demographics, primary diagnosis, residual small bowel length, percent expected small bowel length, median serum citrulline level, number of abdominal operations, status of the ileocecal valve (ICV), presence of ileostomy, liver function tests, and treatment for bacterial overgrowth were recorded for each patient.Median age at PN onset was 0 weeks [IQR 0-0]. Median residual small bowel length was 33.5 cm [IQR 20-70]. NEC was present in 37 of 109 (33.9%) of patients. 45 patients (41%) achieved enteral autonomy after a median PN duration of 15.3 [IQR 7.2-38.4]months. Overall, 64.9% of patients with NEC achieved enteral autonomy compared to 29.2% of patients with a different primary diagnosis (p=0.001, Fig. 1). Patients with NEC remained more likely than those without NEC to achieve enteral autonomy after two (45.5% vs. 12.0%) and four (35.7% vs. 6.3%) years on PN (Fig. 1). Logistic regression analysis demonstrated the following parameters as independent predictors of enteral autonomy: diagnosis of NEC (p0.002), median serum citrulline level (p0.02), absence of a jejunostomy or ileostomy (p=0.013), and percent expected small bowel length (p=0.005).Children with SBS because of NEC have a significantly higher likelihood of fully weaning from parenteral nutrition compared to children with other causes of SBS. Additionally, patients with NEC may attain enteral autonomy even after long durations of parenteral support. |
| Databáze: | OpenAIRE |
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