Establishing norms for intestinal length in children

Struijs, Marie-Chantal; Diamond, Ivan; Silva, Nicole de; Wales, Paul W.

doi:10.1016/j.jpedsurg.2009.01.031

Cited by 254 publications

(203 citation statements)

References 18 publications

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“…Length of the remaining small bowel and colon was obtained from the original operative records and age-adjusted bowel length was calculated based on published age-specific normal values [26]. The type of intestinal circuit was recorded as end-enterostomy, jejunocolic anastomosis or jejunoileocolic anastomosis [27].…”

Section: Methodsmentioning

confidence: 99%

Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure

Mutanen¹,

Mäkitie

Pakarinen³

2013

Horm Res Paediatr

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Aim: To assess bone health in pediatric intestinal failure (IF). Methods: A population-based cohort of 41 IF patients (age 9.9 years) underwent evaluation of bone mineral density (BMD), bone biochemistry, nutritional status and growth. Eleven patients remained on parenteral nutrition (PN) after 69 months. Thirty had weaned off PN 9.0 years earlier (mean), i.e. after 30 months on PN. Results: The majority of patients had lumbar spine or femoral BMD Z-score ≤-1.0 (70%), vitamin D deficiency (serum 25-hydroxyvitamin-D, S-25-OHD, <50 nmol/l, 41%) or secondary hyperparathyroidism (plasma parathyroid hormone >47 ng/l, 44%), equally during and after weaning off PN. Hyperparathyroidism was absent when S-25-OHD was >80 nmol/l. Until puberty, height (-1.4 to -0.8, age 1-12) and weight Z-scores (-1.3 to -0.5, age 1-16) were below the normal mean (p < 0.05). Small bowel length associated with S-25-OHD levels (r = 0.489, p = 0.013). In a multivariate model, time after weaning off PN (β = -0.597, p = 0.001), duration of PN (β = -0.466, p = 0.006) and calcium intake (β = -0.331, p = 0.035) predicted decreased lumbar spine BMD. Conclusions: In pediatric IF, vitamin D insufficiency, secondary hyperparathyroidism and decreased BMD are common. BMD, vitamin D, calcium and nutritional status should be closely monitored during and after weaning off PN to ensure sufficient vitamin D and mineral substitution for normal growth and bone mass attainment.

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Section: Methodsmentioning

confidence: 99%

Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure

Mutanen¹,

Mäkitie

Pakarinen³

2013

Horm Res Paediatr

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“…A consensus estimate from several studies suggests that the average adult human small intestine measures just over 6 m (20 feet) (Gondolesi et al, 2012;Helander and Fandriks, 2014;Hounnou et al, 2002;Weaver et al, 1991). Much of this length is attained prenatally: at birth, the human intestine measures approximately 2.75 m -a remarkable 40% of its adult length (Struijs et al, 2009;Weaver et al, 1991) -and it already exhibits villi and microvilli that further amplify its surface area nearly 100-fold (Helander and Fandriks, 2014). Table 1 summarizes the milestones of intestinal development in humans and mice.…”

Section: Gut Tube Lengtheningmentioning

confidence: 99%

Generation of intestinal surface: an absorbing tale

et al. 2016

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The vertebrate small intestine requires an enormous surface area to effectively absorb nutrients from food. Morphological adaptations required to establish this extensive surface include generation of an extremely long tube and convolution of the absorptive surface of the tube into villi and microvilli. In this Review, we discuss recent findings regarding the morphogenetic and molecular processes required for intestinal tube elongation and surface convolution, examine shared and unique aspects of these processes in different species, relate these processes to known human maladies that compromise absorptive function and highlight important questions for future research.

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“…Bowel length: The residual small and large bowel length in cm as well as percentage of bowel length normalized to patient's height were determined intra-operatively at the first abdominal surgery (13). Ultrashort bowel was defined as 20 cm.…”

Section: Study Definitionsmentioning

confidence: 99%

Pediatric Intestinal Transplant Listing Criteria – A Call for a Change in the New Era of Intestinal Failure Outcomes

Burghardt

Wales

Silva³

et al. 2015

American Journal of Transplantation

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Current listing indications used for intestinal transplantation (IT) were proposed in 2001. We undertook the present single center study to see if these criteria are still valid. The 2001 criteria (advanced cholestasis, loss of >50% central venous catheter (CVC) sites, !2 sepsis/year, ultrashort bowel) were compared in children with intestinal failure in old era-1998-2005 (N ¼ 99) to current era-2006-2012 (N ¼ 91) to predict the need for IT using sensitivity, specificity, NPV and PPV. Two 2001 criteria had poorer predictive value in the current era: Advanced cholestasis (PPV 64% old vs. 40% current era; sensitivity 84% vs. 65%, respectively) and ultrashort bowel (PPV 100% old vs. 9% current era; sensitivity 10% vs. 4%, respectively). Three newly proposed criteria had high predictive value: !2 ICU admissions (p ¼ 0.0001, OR 23.6, 95% CI 2.7-209.8), persistent bilirubin >75 mmol/L despite lipid strategies (p ¼ 0.0005, OR 24.0, 95% CI 3.2-177.4), and loss of !3 CVC sites (p ¼ 0.0003, OR 33.3,).There was 98% probability of needing IT when two of these new criteria were present. The 2001 IT criteria have limited predictive ability in the current era and should be revised. A multicenter study is required to validate the findings of this single center experience.

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Establishing norms for intestinal length in children

Cited by 254 publications

References 18 publications

Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure

Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure

Generation of intestinal surface: an absorbing tale

Pediatric Intestinal Transplant Listing Criteria – A Call for a Change in the New Era of Intestinal Failure Outcomes

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