Enteral autonomy in pediatric short bowel syndrome: predictive factors one year after diagnosis

PurposeThis study examined predictors of achieving enteral autonomy among pediatric short bowel syndrome (SBS) patients remaining on parenteral nutrition (PN) beyond one year.MethodsA retrospective single-institution study of 171 pediatric SBS patients (defined as ≥ 50% small bowel (SB) loss or ≥ 60 days of PN with onset before 6 weeks of age) was performed. Multivariate Cox proportional hazards analysis was conducted, with subgroup analysis of patients on PN for ≥ 1 year (n = 59). Primary outcome was successful wean from PN.ResultsOver a follow-up of 4.1 ± 4.8 years, 64.3% of children weaned from PN. Mortality was 15.2%. Presence of ≥ 10% expected SB length (hazard ratio [HR] 6.48, p = 0.002) or an ileocecal valve (ICV; HR, 2.86, p < 0.001) predicted PN weaning. Of those on PN ≥ 1 year, the wean rate was 50.8%, and ICV no longer predicted weaning (p = 0.153). Predictors among those on PN ≥ 1 year were: ≥ 10% expected SB length (HR, 8.27, p = 0.010), intestinal atresia (HR, 4.26, p = 0.011), and necrotizing enterocolitis (NEC, HR, 2.84, p = 0.025).ConclusionsSBS children on PN ≥ 1 year continue to wean from PN, and those with ≥ 10% of predicted SB length, NEC, or atresia are more likely to do so. These findings may help direct management and advice for these challenging patients.