Small Bowel Dilatation Predicts Prolonged Parenteral Nutrition and Decreased Survival in Pediatric Short Bowel Syndrome

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http://hdl.handle.net/10138/297799

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Hukkinen , M , Kivisaari , R , Merras-Salmio , L , Koivusalo , A & Pakarinen , M P 2017 , ' Small Bowel Dilatation Predicts Prolonged Parenteral Nutrition and Decreased Survival in Pediatric Short Bowel Syndrome ' , Annals of Surgery , vol. 266 , no. 2 , pp. 369-375 . https://doi.org/10.1097/SLA.0000000000001893

Title: Small Bowel Dilatation Predicts Prolonged Parenteral Nutrition and Decreased Survival in Pediatric Short Bowel Syndrome
Author: Hukkinen, Maria; Kivisaari, Reetta; Merras-Salmio, Laura; Koivusalo, Antti; Pakarinen, Mikko P.
Contributor: University of Helsinki, Children's Hospital
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, Clinicum
University of Helsinki, Lastenkirurgian yksikkö
University of Helsinki, Lastenkirurgian yksikkö
Date: 2017-08
Language: eng
Number of pages: 7
Belongs to series: Annals of Surgery
ISSN: 0003-4932
URI: http://hdl.handle.net/10138/297799
Abstract: Objective: To analyze risk factors and prognostic significance of small bowel (SB) dilatation in children with short bowel syndrome (SBS). Background: In SBS, the remaining SB may dilate as part of intestinal adaptation. The impact of dilatation on parenteral nutrition (PN) dependence and survival has not been studied systematically. Methods: SB diameter of SBS children (n = 61) was measured in contrast SB series (n = 169, median age 0.94, range 0.32-2.7 years) during 2002 to 2015, and expressed as millimeters (SB width) and as ratio to L5 vertebra height (SB diameter ratio). Linear regression was used to examine risk factors for dilatation. PN weaning and survival were analyzed with Cox proportional hazards regression. Results: Maximal SB diameter ratio during follow-up was predicted by PN dependence and SB atresia, while maximal absolute SB width by birth weight, age, PN duration, and remaining bowel length. Weaning off PN was 14-fold more likely in patients with maximal SB diameter ratio <2.00 compared with > 3.00 (P = 0.005), and 5.4-fold more likely when maximal SB width was <20mm compared with > 30mm (P = 0.023). After adjustment for age, remaining SB length, and the presence of ileocecal valve, both estimates of maximal SB dilatation remained significant independent predictors for weaning off PN. When all measurements were included, the cumulative survival was worse if SB diameter ratio exceeded 2.00 (P = 0.002-0.042). Conclusions: SB dilatation predicts prolonged PN duration and decreased survival in SBS children. Measurement of maximal SB diameter standardized to L5 vertebra height may be a valuable objective tool for patient follow-up and assessment of prognosis.
Subject: short bowel syndrome
small bowel dilatation
tapering surgery
SERIAL TRANSVERSE ENTEROPLASTY
INTESTINAL RECONSTRUCTION SURGERY
BACTERIAL OVERGROWTH
ENTERAL AUTONOMY
SMOOTH-MUSCLE
CHILDREN
FAILURE
GASTROSCHISIS
ADAPTATION
OUTCOMES
3126 Surgery, anesthesiology, intensive care, radiology
3123 Gynaecology and paediatrics
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