20. Mortality and Outcomes of Pediatric Short Bowel Syndrome: Redefining Predictors of Success
Ariel U. Spencer, MD*, Andreea Neaga, B.S.*, Brady West, M.A.*, Jared Safran, B.A.*, Daniel H. Teitelbaum, MD*
University of Michigan, Ann Arbor, MI (Sponsored by: Arnold Coran, MD)
OBJECTIVE(S): Pediatric short bowel syndrome (SBS) carries high morbidity and mortality, but previous analyses have been limited by small study size. We examined predictors of mortality and ability to wean off total parenteral nutrition (TPN) in a large group of SBS patients.
METHODS: Over 10 years, 99 children developed SBS requiring TPN. Primary outcome measures (available in 94) were mortality and ability to wean off TPN. Cox regression analysis was performed to assess potential predictors of outcomes. Covariates analyzed included cholestasis (conjugated bilirubin >2.5mg/dL), diagnosis, presence of ileocecal valve (ICV), and small bowel length (SBL).
RESULTS: 51/94 were male. Etiologies (not mutually exclusive) included necrotizing enterocolitis (n=38), volvulus (n=20), gastroschisis (n=19), intestinal atresia (n=16), and other (n=12). 61% developed SBS within the first two weeks of life, and 89% within the first year. Survival was 77% (72/94), with 64% of deaths within one year of SBS onset. Cholestasis was highly predictive of mortality (relative risk (RR)=59.3, 95% confidence interval (C.I.): 6.3-557.3, P<0.0005). ICV (P=0.8) and SBL (P=0.5) were not predictive of mortality. However, both predicted weaning from TPN (ICV present: RR=2.38, 95% C.I.: 1.32-4.28, P=0.004; and SBL ≥70 cm, RR=2.09, 95% C.I.: 1.11-3.91, P=0.02).
CONCLUSIONS: SBS mortality increases dramatically with cholestasis. Despite previous studies suggesting ICV and SBL predict survival, neither was significant. Ability to wean from TPN improves in patients with an ICV and more remnant bowel. Prevention of TPN-associated cholestasis and salvage of maximum bowel possible - especially the ICV - are critical determinants of outcome in SBS.