Spencer AU et al. (2005) Pediatric short-bowel syndrome: redefining predictors of success. Ann Surg 242: 403–412

Pediatric short-bowel syndrome (SBS), the congenital or acquired loss of a significant portion of the small intestine, is associated with high morbidity and mortality rates, and limited conclusive evidence exists to predict the survival of such patients. Spencer and colleagues have therefore carried out a retrospective review of 80 pediatric SBS patients, ≤6 weeks of age, in order to determine the predictors of survival and weaning off parenteral nutrition.

In total, 22 of the 80 patients died and 51 were weaned off parenteral nutrition over the mean 5.1 years of follow-up. Cholestasis was found to be a strong predictor of death when conjugated bilirubin was ≥42.75 μmol/l (2.5 mg/dl). Absolute small-bowel length was only marginally predictive of survival; however, when taken as a percentage of the expected length for gestational age (to accommodate for the disparity in gestational age of the patients, as rapid increases in bowel length occur late in gestation) the length of remaining bowel is highly significant, and those with <10% of that expected length had the poorest prognosis. In terms of weaning off parenteral nutrition, a small-bowel length ≥10% of that expected was predictive of success and those patients who had retained their ileocecal valve were also more likely to be weaned.

The authors conclude that these results allow for improved outcome prediction in pediatric SBS patients, in terms of survival and weaning from parenteral nutrition, which in turn might help clinicians to manage such patients.