PROSPECTIVE EVALUATION OF FECAL FATTY-ACID EXCRETION IN SHORT-BOWEL SYNDROME IN NEWBORNS

Short bowel syndrome (SBS) in the newborn results in limited intestina l absorptive capacity, leading especially to fatty acid (FA) malabsorp tion. It is unknown whether adaptation occurs in time in FA absorption , and whether this adaptation is chain-length dependent. The aim of th e present study was to prospectively evaluate FA absorption and excret ion during SBS in the newborn. Twenty-one neonates who underwent small bower resection (of variable length) for various reasons (necrotizing enterocolitis, intestinal atresia, meconium peritonitis, cloacal extr ophy, etc) were studied. Eight neonates had SBS, defined as a small bo wel remnant of less than 50% of the original small bowel length relate d to gestational age. The mean remaining small bowel length in the SBS group was 34% (24% to 42%). The non-SBS control group consisted of 13 neonates who had only minor small bowel resections. The mean remainin g bower length for the non-SBS group was 95% (70% to 100%). The result s show that the total fractional excretion of FA (FE-FA) at 2 weeks an d 1, 2, 3, and 4 months postsurgery was 51% +/- 37%, 33% +/- 24%, 51% +/- 65%, 53% +/- 27%, and 7% +/- 2% in patients with SBS, versus 12% /- 8%, 24% +/- 10%, 9% +/- 3%, 8% +/- 3% and 17% +/- 14% in the non-SB S controls, respectively (P < .05 by ANOVA). There appeared to be an a melioration in time in FA absorption, especially in the SBS group, aft er 3 months. FE-FA was chain-length related, being considerably less f or C10 and C12 than for C14 and longer amounts. An amelioration of abs orption occurred in the SBS patients, especially with the longer-chain FA. On the basis of the study data, the authors conclude that in the initial adaptation phase shorter chain lengths are better absorbed tha n longer chain lengths; however, in the latter FA group, substantial a daptation occurs with time. (C) 1996 by W.B. Saunders Company