Analysis of risk factors for neonatal short bowel syndrome in two tertiary centers in Brazil

Abstract

Introduction: Short bowel syndrome (SBS) is defined as a severe reduction in intestinal mucosal absorption secondary to reduced intestinal functional area. The main causative factor for SBS is the length of intestinal resection in the neonatal period. The prognosticating factors are age, length of remnant intestine, preserved ileocecal valve, and venous maintenance. Objective: To evaluate the clinical and surgical aspects affecting survival outcomes in neonates with SBS at two tertiary care centers. Patients & methods: Retrospective cohort study involving two university tertiary care neonatal centers with diagnosed SBS. Neonates were allocated into two groups, SBS (<60 cm) and USBS (ultra-short bowel syndrome) (<25 cm) and demographically compared. Results: In total, 53 neonates met the inclusion criteria, with 31 and 22 in the SBS and USBS, respectively; 20 survived and 33 died (37 % survival rate). The remnant bowel length was greater in those with SBS (p < 0.001), with greater ability to acquire full adaptation (p = 0.047). Increased survival rate was associated with use of total parenteral nutrition (TPN) (p = 0.002) and enteral nutrition (p = 0.036), and the ability to acquire full intestinal adaptation (p = 0.047). Risk factors associated with mortality were the inability to tolerate enteral nutrition (p = 0.036) and acquire full intestinal adaptation (p < 0.001); Use of TPN proved to be protective against death (p = 0.002). Conclusion: SBS has high mortality rates in neonatal period (57 %). We recommend caution with time taken to full intestinal adaptation, with continued TPN administration during this time, which can improve overall survival outcomes.