OUTCOMES OF LOW‐BIRTH‐WEIGHT INFANTS WITH SURGICAL SHORT BOWEL SYNDROME

Abstract

Short bowel syndrome (SBS) is a devastating clinical problem in low birth weight neonates. Aims: To determine 1) incidence of SBS in very low birth weight (VLBW; <1500 g) infants; 2) incidence, morbidity, mortality and growth in extremely low birth weight (ELBW; <1000 g) infants. Methods: Data were prospectively collected from infants born 01/01/02-06/30/04 who survived >12 hours and received care at 16 NICHD Neonatal network centers. They were followed until hospital discharge/death/120 days. ELBW survivors were evaluated for follow-up (f/u) at 18-22 months corrected age. The distribution of and risk factors for developing surgical SBS were evaluated. Results: Cohort consisted of 8681 VLBW infants. 105(1.2%) had surgical SBS (0.3-2.5% across centers). Relative risk of SBS was inversely related to birth weight (BW) (p < 0.001). 13% of infants with NEC had SBS compared to 0.3% of those without (p < 0.001). 3695 ELBW infants were classified as SBS (1.8%), Medical NEC without SBS (4%), Surgical NEC without SBS (5.1%), No NEC or SBS (89.1%). There were more male infants with SBS (p = 0.014). During the initial hospital stay, SBS infants were more likely to develop sepsis, severe intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA) and be treated with steroids for BPD. More SBS infants (36%) died during the initial hospitalization than those without NEC or SBS (22%), but less than infants with Surgical NEC without SBS (52%). 1060 children have completed the f/u visit. Compared to other groups, more infants with SBS were tube fed and had been re-hospitalized at f/u. There was no difference between the weights of SBS infants and other infants at f/u. However, SBS infants had lower length and head circumference than infants without NEC or SBS (p < 0.05). Conclusion: ELBW infants with SBS have higher mortality during the initial hospital stay. Lower BW, NEC, PDA, IVH and postnatal steroid use were associated with SBS. At f/u, these children were more likely to have lower length and head circumference. This suggests the need for intensive nutritional therapy in these children.