INFLUENCE OF BACTERIAL OVERGROWTH AND INTESTINAL INFLAMMATION ON DURATION OF PARENTERAL-NUTRITION IN CHILDREN WITH SHORT-BOWEL SYNDROME CHILDREN

Objectives: Massive intestinal resection results in short bowel syndro me and necessitates prolonged parenteral feeding. The purpose of this work was to assess the impact of late complications of short bowel syn drome, including intestinal bacterial overgrowth and enterocolitis, on the duration of parenteral nutrition (PN) in comparison with factors evident in the neonatal period. Methods: Retrospective chart review. R esults: Of 49 children, 42 were weaned from parenteral nutrition after a treatment course of 17 +/- 14 months. In these 42, postresection sm all intestinal length equaled 81 +/- 65 cm; 45% had an ileocecal valve . Small intestinal length in the seven children who were PN dependent was 31 +/- 30 cm (p < 0.05); none had an ileocecal valve (p < 0.05). B acterial overgrowth occurred in all seven PN-dependent children and in 23 of 42 children eventually weaned from PN (p < 0.05). When bacteria l overgrowth was identified before weaning (n = 12), the duration of P N was 28 +/- 17 months, but when bacterial overgrowth was first identi fied only after weaning (n = 11), the duration of PN was 16 +/- 13 mon ths (p < 0.05). Small intestinal inflammation correlated with bacteria l overgrowth (r = 0.69). Those children with severe enteritis identifi ed before weaning remained on the PN regimen for 36 +/- 15 months, in comparison with 21 +/- 14 months in those with mild enteritis and 13 /- 11 months in those without inflammation (p < 0.02). Conclusions: Al though the length of small intestine remaining after resection is the best immediate predictor of final success in terminating PN in childre n with short bowel syndrome, PN is prolonged by bacterial overgrowth a nd associated enteritis in those who will ultimately be weaned.