Early Structured Surgical Management Plan for Neonates with Short Bowel Syndrome May Improve Outcomes

• Published in: World journal of surgery Vol. 37; no. 7; pp. 1714 - 1717
• Main Authors: Wood, S. J., Khalil, B., Fusaro, F., Folaranmi, S. E., Sparks, S. A., Morabito, A.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2013; Springer‐Verlag; Springer Nature B.V
• Subjects: Abdominal Surgery; Age Factors; Bowel Length; Cardiac Surgery; Child, Preschool; Female; Gastroschisis; General Surgery; Humans; Infant; Infant, Newborn; Intestine, Small - surgery; Male; Medicine; Medicine & Public Health; Parenteral Nutrition; Patient Care Planning; Retrospective Data Collection; Retrospective Studies; Short Bowel Syndrome; Short Bowel Syndrome - rehabilitation; Short Bowel Syndrome - surgery; Surgery; Thoracic Surgery; Treatment Outcome; Vascular Surgery; Gastroschisis; Parenteral Nutrition; Short Bowel Syndrome; Bowel Length; Retrospective Data Collection
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-013-2011-z

Background In children with short bowel syndrome, maximal adaptation of the bowel after extensive resection is thought to occur during the first 2 years of life. The aim of the present study was to review children with short bowel syndrome from two intestinal rehabilitation centers, comparing those undergoing lengthening procedures <365 days of age (early) versus those whose lengthening procedure was carried out >365 days of age (late). Methods Retrospective data collection was performed from January 2004 to December 2010 in Manchester, UK, and from December 2006 to December 2010 in Brussels, Belgium. Both medical centers follow a similar intestinal rehabilitation program (IRP). Data collected included population demographics, bowel length preoperatively and postoperatively, age at operation, parenteral nutrition (PN), central access, and complications. Results Complete data were available for eight children who underwent lengthening surgery at <365 days of age, and six who underwent the procedure at >365 days of age. Diagnoses were similar. Groups were matched for gestation and birthweight, with no statistical difference in preoperative and postoperative bowel lengths. The mean duration of PN postoperatively was 378 days in the early cohort and 589 days in the late cohort. This trended toward statistical significance ( p  = 0.071). Full enteral autonomy was achieved at 17 months (early) and 59 months (late) ( p  = 0.01). Patients in the early group required fewer central lines than those operated on later ( p  = 0.035). Conclusions Enrolling children into an IRP involving early (<365 days of age) lengthening surgery allows a shorter postoperative time to allow weaning to full enteral nutrition, as well as fewer central lines. Both outcomes provide benefits for the child and family, allowing an earlier return to normal life.