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Neonates with Short Bowel Syndrome: An Optimistic Future for Parenteral Nutrition Independence
*Erica M. Fallon, *Deepika Nehra, *Paul D. Mitchell, *Alexis K. Potemkin, *Alison A. O’Loughlin, *Elizabeth M. Robinson, *Kathleen M. Gura, Mark Puder
Children's Hospital Boston and Harvard Medical School, Boston, MA

Objective: To determine the probability of weaning from parenteral nutrition (PN) based on intestinal length in neonates with short bowel syndrome amidst the new era of hepatoprotective strategies and multidisciplinary management.

Design: Retrospective review

Setting: Single-center academic institution

Patients or Other Participants: Neonates with ≤100cm small intestine at ≤30 days corrected gestational age, diagnosed with a surgical gastrointestinal disease and PN-dependent for ≥2 weeks from 2003-2012. Patients who underwent a bowel lengthening procedure were excluded.

Main Outcome Measure(s): The probability of weaning from PN without re-initiation for ≥1 year, as determined by logistic regression.

Results: Fifty-five patients with median(IQR) gestational age 29(26,35)weeks, birth weight 1215(860,2443)g, and small intestinal length 45(21,65)cm were analyzed. Of these, 78% received a fish oil-based lipid emulsion (1g/kg/day), 38(69%) were weaned, 6(11%) remained PN-dependent, 5(9%) were transplanted, and 6(11%) died. Excluding transplanted and deceased patients, the median small intestinal length in weaned patients was 56(35,75)cm compared to 21(6,35)cm in PN-dependent patients (P=0.008), with 86% of patients weaned by study end (Figure 1a). The cumulative probability of wean for patients with <50cm small intestine was 50% by 28.3months and 75% by 55.1months while for patients with ≥50cm small intestine, 50% weaned within 4.6months and 75% by 7.2months (Figure 1b).

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

Figure 1. (a) The predicted probability of PN wean according to small intestinal length (N=44). (b) The cumulative probability of wean according to PN duration (N=44). Patients who underwent transplantation (N=5) and those who died (N=6) were excluded.

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