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

To analyze the outcome of children with short bowel syndrome (SBS) who required long-term parenteral nutrition (PN).Retrospective analysis of children (n=78) with SBS who required PN3 months from 1975 to 2000.univariate analysis, Kaplan-Meier method, and Cox proportional regression model were used.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 of15 cm (P.01) were associated with a higher mortality. Intestinal adaptation was less likely if SBL15 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.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 with15 cm of SBL and patients with SBL15 cm without ICV have a chance of intestinal adaptation.