Neonates With Short Bowel Syndrome

Fallon, Erica M.; Mitchell, Paul D.; Nehra, Deepika; Potemkin, Alexis K.; O’Loughlin, Alison A.; Gura, Kathleen M.; Puder, Mark

doi:10.1001/jamasurg.2013.4332

Cited by 94 publications

(32 citation statements)

References 44 publications

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“…Small bowel length has consistently been the most robust indicator and historical data suggest that approximately 35cm of small bowel is associated with a 50% probability of weaning from PN[3, 4, 10, 17, 18, 32]. However, wide variability exists around this benchmark, and some patients with less than 10cm of remaining small bowel have achieved enteral autonomy[15, 19–21]. Serum citrulline thresholds of 15μmol/L and 10μmol/L have been suggested to predict likelihood of weaning from parenteral nutrition as well as risk of CLABSI infection, respectively [30, 31].…”

Section: Discussionmentioning

confidence: 99%

Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome

Sparks

Khan

Fisher

et al. 2016

Journal of Pediatric Surgery

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Purpose 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. Methods 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. Results Median age at PN onset was 0 weeks [IQR 0–0]. Median residual small bowel length was 33.5cm [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, Figure 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 (Figure 1). Logistic regression analysis demonstrated the following parameters as independent predictors of enteral autonomy: diagnosis of NEC (p<0.002), median serum citrulline level (p<0.02), absence of a jejunostomy or ileostomy (p=0.013), and percent expected small bowel length (p=0.005). Conclusions Children with SBS due to 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.

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Section: Discussionmentioning

confidence: 99%

Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome

Sparks

Khan

Fisher

et al. 2016

Journal of Pediatric Surgery

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“…Probiotic use to reduce NEC has been the subject of several recent reviews. [163][164][165] A 2011 Cochrane review based on 16 trials (2,842 infants) concluded that enteral probiotic supplementation to preterm infants less than 2,500 g birth weight significantly reduced the incidence of severe NEC (stage II or more) and mortality. 163 Based on the 2011 Cochrane review, the American Pediatric Surgical Association Outcomes and Clinical trial Committee advised the use of probiotics to decrease the incidence of NEC.…”

Section: Necrotizing Enterocolitismentioning

confidence: 99%

Early Development of the Gut Microbiome and Immune-Mediated Childhood Disorders

2014

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The human gastrointestinal tract inhabits a complex microbial ecosystem that plays a vital role in host health through its contributions to nutrient synthesis and digestion, protection from pathogens, and promoting maturation of host innate and adapt immune systems. The development of gut microbiota primarily occurs during infancy and is influenced by multiple factors, including prenatal exposure; gestational age; mode of delivery; feeding type; pre-, pro-, and antibiotic use; and host genetics. In genetically susceptible individuals, changes in the gut microbiota induced by environmental factors may contribute to the development of immune-related disorders in childhood, including atopic diseases, inflammatory bowel disease, irritable bowel syndrome, and necrotizing enterocolitis. Pre- and probiotics may be useful in the prevention and treatment of some immune-related diseases by modulating gut microbiota and regulating host mucosal immune function. The review will discuss recent findings on the environmental factors that influence development of gut microbiota during infancy and its potential impact on some immune-related diseases in childhood. The use of pre- and probiotics for prevention and intervention of several important diseases in early life will also be reviewed.

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“…A combination of lengthening techniques along with transit slowing efforts may be considered for gastrointestinal reconstruction [3]. Transit slowing procedures have been largely abandoned.…”

Section: Surgical Treatmentmentioning

confidence: 99%

New Insights and Interventions for Short Bowel Syndrome

Rouch

Dunn

2017

Curr Pediatr Rep

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Purpose of review This review summarizes recent innovations in the treatment of patients with short bowel syndrome. Recent findings The use of surgical procedures, growth factor stimulation, and bioengineering approaches to increase absorptive surface area of the intestine is examined. While the morphology of the intestine is clearly altered by these interventions, it is less clear that the overall function of the intestine is improved. Summary Continued innovations will likely bring about new therapeutic options for patients with short bowel syndrome. Careful evaluations of the impact of these interventions await controlled clinical trials.

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Neonates With Short Bowel Syndrome

Abstract: The majority of patients will wean from PN despite short intestinal length, likely as a result of new management strategies combined with a multidisciplinary team approach.

Cited by 94 publications

References 44 publications

Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome

Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome

Early Development of the Gut Microbiome and Immune-Mediated Childhood Disorders

New Insights and Interventions for Short Bowel Syndrome

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