Small and large bowel anatomy is associated with enteral autonomy in infants with short bowel syndrome: A retrospective cohort study

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Tipo de produção
article
Data de publicação
2024
DOI
Scopus
Web of Science
PubMed
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Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY
Autores
ROBERTS, Amin J.
WALES, Paul W.
BELZA, Christina
DOGRA, Harween
EVANS, Helen M.
GATTINI, Daniela
HIND, Jonathan
MERCER, David
Citação
JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, v.48, n.2, p.231-238, 2024
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Achievement of enteral autonomy (EA) is the ultimate treatment goal in pediatric intestinal failure (IF). We aimed to assess predictors of EA in pediatric short bowel syndrome (SBS) and explore the impact of residual small bowel (SB) and large bowel (LB) length on EA.Methods: A retrospective cohort study was performed on infants aged <12 months (n = 367, six centers) with SBS referred between 2010 and 2015. The cohort was stratified based on the achievement of EA. Statistical testing was completed using t-test, chi-square, Cox proportional hazards regression model, and Kaplan-Meier analysis.Results: EA was achieved in 229 patients. In the multivariable analysis, the percentage of residual LB (hazard ratio [HR] = 1.02; 95% CI = 1.01-1.02) and SB (HR = 1.01; 95% CI = 1.01-1.02) length, presence of the ileocecal valve (HR = 2.02; 95% CI=1.41-2.88), and not coming from a high-volume transplantation center (HR = 2.42; 95% CI = 1.68-3.49) were positively associated with EA, whereas a negative association was seen with the presence of stoma at the time when shortest remnant was documented (HR = 0.72; 95% CI = 0.52-1.00). EA achievement was significantly different between the anatomical subgroups (log-rank test P < 0.001) with an EA rate of 80.4% in infants with >= 50% SB and LB (median time 209 days); 62.5% with >= 50% SB and <50% LB (397 days); 58.3% with <50% SB and >= 50% LB (1192 days), and 25.9% with <50% SB and LB. Necrotizing enterocolitis (NEC) was not associated with a better achievement of EA (NEC vs other etiologies: log-rank test P = 0.33).Conclusions: Overall, 62% of infants with IF secondary to SBS achieved EA over a mean time of follow-up of 2.3 years. A colon length of >50% can compensate for the loss of small bowel (<50%) and account for similar EA rates as those in children with residual SB > 50%.
Palavras-chave
enteral autonomy, intestinal failure, multicenter, parenteral nutrition, pediatrics, short bowel syndrome
URI
https://observatorio.fm.usp.br/handle/OPI/59216
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICr