Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: A 25-year experience

Objective To analyze the outcome of children with short bowel syndrome (SBS) who required long-term parenteral nutrition (PN). Study design Retrospective analysis of children (n=78) with SBS who required PN >3 months from 1975 to 2000. Statistics: univariate analysis, Kaplan-Meier method, and Cox proportional regression model were used. Results We identified 78 patients. Survival was better with small bowel length (SBL) >38 cm, intact ileocecal valve (ICV), intact colon, takedown surgery after ostomy (all P < .01), and primary anastomosis (P < .001). PN-associated early persistent cholestatic jaundice (P < .001) and SBL of <15cm (P < .01) were associated with a higher mortality. Intestinal adaptation was less likely if SBL <15 cm (P < .05), ICV was removed, colonic resection was done (both P < .001), >50% of colon was resected (P < .05), and primary anastomosis could not be accomplished (P < .01). Survival was 73% (57), and 77% (44) of survivors had intestinal adaptation. Conclusions SBL, intact ICV, intestinal continuity, and preservation of the colon are important factors for survival and adaptation. Adaptation usually occurred within the first 3 years. Need for long-term PN does not preclude achieving productive adulthood. Patients with ICV even with <15 cm of SBL and patients with SBL >15 cm without ICV have a chance of intestinal adaptation.