Predicting time to full enteral nutrition in children after significant bowel resection

Infographic · Oct 2018 · 1 min read

In brief

Retrospective study of 71 children post-bowel resection found that remaining small bowel length and percentage of expected bowel for gestational age strongly predict duration of parenteral nutrition dependence. Children retaining 25-50% of small bowel required approximately 2 years on PN versus 1 year for those with 51-75%, independent of underlying etiology or anatomic factors like ileocecal valve presence.

Small bowel length and percent of expected bowel for gestational age strongly predict PN duration after resection (p<0.01).
Children retaining 25-50% of small bowel require ~2 years of PN vs ~1 year for those with 51-75% remaining.
Presence of ileocecal valve, colon, or anastomosis location do not independently predict time to full enteral nutrition.
Linear regression model using remaining bowel length can estimate PN dependence duration in pediatric short bowel syndrome.
Etiology of intestinal loss (NEC, atresia, gastroschisis) does not affect time to wean from parenteral nutrition.

Written by the GCMD Library team from the infographic.

The infographic uses a split-panel design with two blue boxes showing simplified digestive system illustrations. The left panel depicts 51-75% remaining bowel length, the right shows 25-50%. A central white box lists factors that did not affect TPN duration. Red text highlights the key finding at the bottom.

Purpose

Parenteral nutrition (PN) contributes to considerable morbidity in children after significant bowel resection. This study evaluates the utility of clinical variables in predicting time to independence from PN.

Methods

After IRB approval, a retrospective review (1999–2012) of 71 children who were on PN for >6 weeks after intestinal resection and successfully weaned was performed. Clinical characteristics were evaluated to determine the relationship to time to full enteral nutrition. P-values < 0.05 were significant.

Results

Most children had necrotizing enterocolitis (56%), intestinal atresia (20%), or gastroschisis (11%) with a median small bowel length of 55 cm (IQR, 35–92 cm). The duration of PN was independent of the etiology of intestinal loss, presence of the ileocecal valve or colon, or location of anastomosis, but was strongly associated with small bowel length (<0.01) and percent of expected small bowel based on gestational age (GA) (median 50%, <0.01). In general, children who had 25–50% of their small bowel were dependent on PN for at least 2 years compared to approximately 1 year for those with 51–75%.

Conclusion

The duration of PN dependence in children after major bowel resection is best predicted by remaining small bowel length and can be estimated using a linear regression model.