PREDICTING THE DURATION OF DEPENDENCE ON PARENTERAL-NUTRITION AFTER NEONATAL INTESTINAL RESECTION

Objective: To determine whether there are clinical or physical factors that could be used to predict the duration of dependence on parentera l nutrition (PN) in infants who have undergone resection of small inte stine in the neonatal period, Study design: Medical records of 44 pati ents who had small intestinal resection as neonates from 1985 to 1996 and who were dependent on PN for at least 3 months were reviewed. Stat istical evaluation of patient variables and their impact on duration o f dependence on PN were determined by using the Cox Proportional Hazar d model. Results: Twenty-seven patients became independent of PN befor e the age of 36 months. Seven patients between 40 and 129 months of ag e are permanently dependent on PN. Outcome could not be determined in 10 patients, four Of cr-hom died of hepatic failure while still receiv ing PN and six of whom are still receiving PN but are younger than 36 months of age. Small bowel length after initial surgery and the percen t of daily energy intake received by the enteral route at 12 weeks' ad justed age were significantly related to the duration of dependence on PN. Gestational age, presence of the ileocecal valve, and development of cholestasis were nor significantly related. With the use of the Co x Proportional Hazards survival model, a Formula was generated to allo w estimation of the duration of dependence on PN. Conclusions: The dur ation of dependence on PN can be predicted at an early age in neonatal short bowel syndrome by using two patient variables: the length of re sidual small bowel after initial surgery and thr percent of daily ener gy-intake tolerated through the enteral route.