In the management of short gut, alternatives to long term total parenteral nutrition (TPN) exist, ranging from enteral feeding only to interventional, surgical management such as gut transplant or gut lengthening procedures. To understand attitudes and practice concerning short gut management, a survey was sent in the spring of 1997 to the directors of 102 Neonatology (Neo) and 47 Gastroenterology (GI) fellowship programs with 70% and 85% response respectively. Chi square with Yates correction and Wilcoxon matched paired analysis are used as appropriate.

The GI respondents are more willing than the Neos to consider both more and less aggressive alternatives than TPN (table). We could not explain why Neos are less willing to consider alternatives, especially as Neos are less satisfied with the results of TPN, being significantly more pessimistic regarding survival (P=0.001) and quality of life(P=0.011) than GIs. Moreover, GIs were no more optimistic than Neos about either survival after both of the surgeries (that the GIs were willing to recommend) or about the quality of life after transplant (P=0.86). GIs did perceive quality of life as better for palliation than did Neos(P=0.019), but that by itself does not explain the whole difference. Other factors that might play a role in explaining these differences are the greater continuous involvement of the Neos in the day-to-day management of these patients early in their course or the fact that Neos had less personal experience with the surgical treatments (P=0.004), but it is unclear whether these factors fully explain these differences. These disagreements, however hard to interpret, may pose ethical problems as both groups of professionals counsel parents.

Table 1 No caption available.
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