PEDIATRICS Vol. 122 No. 3 September 2008, pp. e573-e582 (doi:10.1542/peds.2007-3449)
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ARTICLE |
Very Low Birth Weight Preterm Infants With Surgical Short Bowel Syndrome: Incidence, Morbidity and Mortality, and Growth Outcomes at 18 to 22 Months
Departments of a Pediatrics
d Medicine, Emory University School of Medicine, Atlanta, Georgia
b RTI International, Research Triangle Park, North Carolina
c Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
OBJECTIVES. The objective of this study was to determine the (1) incidence of short bowel syndrome in very low birth weight (<1500 g) infants, (2) associated morbidity and mortality during initial hospitalization, and (3) impact on short-term growth and nutrition in extremely low birth weight (<1000 g) infants.
METHODS. Infants who were born from January 1, 2002, through June 30, 2005, and enrolled in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Risk factors for developing short bowel syndrome as a result of partial bowel resection (surgical short bowel syndrome) and outcomes were evaluated for all neonates until hospital discharge, death, or 120 days. Extremely low birth weight survivors were further evaluated at 18 to 22 months' corrected age for feeding methods and growth.
RESULTS. The incidence of surgical short bowel syndrome in this cohort of 12316 very low birth weight infants was 0.7%. Necrotizing enterocolitis was the most common diagnosis associated with surgical short bowel syndrome. More very low birth weight infants with short bowel syndrome (20%) died during initial hospitalization than those without necrotizing enterocolitis or short bowel syndrome (12%) but fewer than the infants with surgical necrotizing enterocolitis without short bowel syndrome (53%). Among 5657 extremely low birth weight infants, the incidence of surgical short bowel syndrome was 1.1%. At 18 to 22 months, extremely low birth weight infants with short bowel syndrome were more likely to still require tube feeding (33%) and to have been rehospitalized (79%). Moreover, these infants had growth delay with shorter lengths and smaller head circumferences than infants without necrotizing enterocolitis or short bowel syndrome.
CONCLUSIONS. Short bowel syndrome is rare in neonates but has a high mortality rate. At 18 to 22 months' corrected age, extremely low birth weight infants with short bowel syndrome were more likely to have growth failure than infants without short bowel syndrome.
Key Words: short bowel syndrome • preterm • necrotizing enterocolitis • nutrition
Abbreviations: SBS—short bowel syndrome • NEC—necrotizing enterocolitis • ELBW—extremely low birth weight • GA—gestational age • VLBW—very low birth weight • NICHD—Eunice Kennedy Shriver National Institute of Child Health and Human Development • PDA—patent ductus arteriosus • IVH—intraventricular hemorrhage • BPD—bronchopulmonary dysplasia • SGA—small for gestational age • RR—relative risk • CI—confidence interval
Accepted May 28, 2008.
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