Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes

Objective: To determine correlates of clinical outcomes in patients with sh ort bowel syndrome (SBS). Methods: Retrospective medical record review of neonates treated between 19 86 and 1998 who met our criteria for SBS: dependence on parenteral nutritio n (PN) for at least 90 days after surgical therapy for congenital or acquir ed intestinal diseases. Results: Thirty subjects with complete data were identified; 13 (43%) had n ecrotizing enterocolitis, and 17 (57%) had intestinal malformations. Mean ( SD) residual small bowel length was 83 (67) cm. Enteral feeding with breast milk (r = -0.821) or an amino acid-based formula (r = -0.793) was associat ed with a shorter duration of PN, as were longer residual small bowel lengt h (r = -0.475) and percentage of calories received enterally at 6 weeks aft er surgery (r = -0.527). Shorter time without diverting ileostomy or colost omy (r = 0.400), enteral feeding with a protein hydrolysate formula (r = -0 .476), and percentage of calories received enterally at 6 weeks after surge ry (r = -0.504) were associated with a lower peals direct bilirubin concent ration. Presence of an intact ileocecal valve and frequency of catheter-rel ated infections were not significantly correlated with duration of PN. In m ultivariate analysis, only residual small bowel length was a significant in dependent predictor of duration of PN, and only less time with a diverting ostomy was an independent predict-or of peak direct bilirubin concentration . Conclusions: Although residual small bowel length remains an important pred ictor of duration of PN use in infants with SBS, other factors, such as use of breast milk or amino acid-based formula, may also play a role in intest inal adaptation. In addition, prompt restoration of intestinal continuity i s associated with lowered risk of cholestatic liver disease. Early enteral feeding after surgery is associated both with reduced duration of PN and le ss cholestasis.