SHORT BOWEL SYNDROME AND CHRONIC INTESTINAL FAILURE: ASSESSMENT OF PROGNOSTIC MARKERS AND EFFECTIVENESS OF REHABILITATION

Abstract

Introduction. The survival rate of children with chronic intestinal failure (IF), a special case of which is short bowel syndrome (SBS), is increasing nowadays. The experience of a 4-stage system of care for children with chronic intestinal failure (IF) and short bowel syndrome (SBS) developed in Children’sCityHospital named after N. F. Filatov is presented. Objectives. The aim was to identify prognostic markers for intestinal adaptation (IA) in children with an extended (more than50 cm) resections of the intestine. Methods. The outcomes were evaluated in 75 children one year after resection and its relations to the preserved small intestine length, extension and cause of resection. Results. Survival of children after 1 and 3 years was 87–89%. The proportion of those who have reached IA was higher (38%) in children with more than60 cm remaining intestine in comparing to those who have less than30 cm and 30–60 cm of intestine (14.5–15%) (p <0.05. After combined resections of intestine and colon more children were dependent on PN (90%) then after intestinal (46%) or colon resections (41%) (p <0.05). Children with acute strangulation and intestinal malformations better achieved IA (50% and 44%) compared with those who underwent resection for necrotizing enterocolitis or diff intestinal neuroand myopathies (0% of IA by 1 year after resection) (р<0,05). By 1 year of following up (N=75) 25% achieved IA, 46% remained dependent on the PN, by 3 years (N=32) 44% achieved IA, 39% were dependent on PN. Conclusion. The remaining intestinal length, extension of resection and the underlying disease infl on 1-year prognosis in children with intestinal resections. Increasing in those who have achieved AI in the course of time allows to conclude that children with IF and SBS have a rehabilitation potential and the developed RP is eff in such patients.