GROWTH AFTER NEONATAL SMALL BOWEL RESECTION

Abstract

5 Few data on long-term growth and final adult height are available in children who have undergone extensive small bowel resection in the neonatal period. Patients and methods: 87 neonates, born between 1975 and 1991 who underwent extensive neonatal small bowel resection, were followed up for a period of 13±4 years. 9 infants died before being weaned from parenteral nutrition (PN). The 78 survivors were divided in 3 groups: group A (n=9), still receive PN; group B (n=12) initially discontinued PN but, thereafter required once again PN or enteral feeding; group C (n=57), achieved permanent digestive autonomy. Anatomical data including small bowel length (SBL) and preservation of the ileocecal valve (ICV) were recorded and multivariate analysis was performed. Data on height and weight were collected from medical files or letters sent to the parents or to the physicians and expressed in standard deviation (SD). Results: The overall survival was 89,7%, depending on the year of birth. The duration of PN depended on SBL and ICV preservation. All Group A patients had SBL <40 cm and/or absence of ICV; they were dependent on PN for 9 to 19 years and grew normally. Group B patients had a 35,4±19,3 cm SBL, a resection of the ICV in 50% of cases and a duration of initial PN of 47±24 months. All presented a significant decrease of height and weight velocity within the 4 years following PN weaning, requiring that enteral or parenteral feeding be resumed. In group C children had a 57,2±18,7 cm SBL, the presence of the ICV in 81 % of cases and a duration of PN of 16±11 months. Although they showed a delay in growth at the cessation of PN, they had a slow catch up growth up between -2SD and +2SD. Their puberty occurred normally and their final height is at 99,7±3,4% of the expected parental height. A catch-up growth was observed in all children born small-for-gestational-age. Conclusion: About 10% of the patients remain permanently dependent on PN. For the others, in spite of extensive intestinal resection, anatomic factors and a short duration of initial PN are predictive of normal long-term growth and final height. On the opposite, growth failure following weaning of a long-term initial parenteral nutrition requires a new period of nutritional support in order to preserve final adult height.