Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Department of Clinical Nutrition Services, Texas Children's Hospital, Houston, Texas, USA.
JPEN J Parenter Enteral Nutr. 2021 Feb;45(2):331-338. doi: 10.1002/jpen.1847. Epub 2020 May 4.
It is challenging to provide optimum nutrition in low-birth-weight (LBW) infants with short-bowel syndrome (SBS) and ostomy. This study aims to evaluate the clinical course of LBW infants with SBS and ostomy in response to enteral feeds, recognize characteristics associated with achievement of enteral autonomy prior to reanastomosis, and evaluate associated short-term outcomes.
A retrospective analysis of 52 LBW neonates with intestinal failure (IF) caused by SBS and ostomy treated in a neonatal intensive care unit from 2012 to 2018 was performed. Clinical characteristics and short-term outcomes were studied in relation to the location of the ostomy and the success with enteral feeding achieved prior to reanastomosis.
Of the 52 infants with SBS, jejunostomy, ileostomy, and colostomy were present in 9, 40, and 3 infants, respectively. Fourteen (26.92%) infants achieved enteral autonomy transiently, and 7 (13.46%) sustained until reanastomosis. All 9 infants with jejunostomy were parenteral nutrition dependent, compared with 22 with ileostomy and none with colostomy (P = 0.002). Infants who achieved enteral autonomy showed lower incidence of cholestasis (P = 0.038) and better growth velocity (P = 0.02) prior to reanastomosis.
A minority of LBW infants with SBS and ostomy achieved enteral autonomy prior to reanastomosis. Distal ostomy (ileostomy and colostomy), reduced cholestasis, and better growth were associated with achievement of enteral autonomy. Our report highlights the challenges in establishing enteral autonomy in LBW infants with IF and ostomy, and the feasibility of that approach in a minority of patients, with tangible benefits.
对于患有短肠综合征（SBS）和肠造口的低出生体重（LBW）婴儿，提供最佳营养极具挑战性。本研究旨在评估对肠内喂养有反应的 LBW 伴有 SBS 和肠造口的婴儿的临床过程，识别在重新吻合前实现肠内自主的相关特征，并评估相关的短期结果。
对 2012 年至 2018 年在新生儿重症监护病房接受治疗的 52 例因 SBS 和肠造口导致肠衰竭（IF）的 LBW 新生儿进行回顾性分析。研究了造口位置和重新吻合前肠内喂养成功与临床特征和短期结果的关系。
在 52 例 SBS 婴儿中，分别有 9 例、40 例和 3 例存在空肠造口、回肠造口和结肠造口。14 例（26.92%）婴儿暂时实现了肠内自主，7 例（13.46%）持续到重新吻合。所有 9 例空肠造口的婴儿都依赖于肠外营养，而 22 例回肠造口的婴儿和无结肠造口的婴儿均未依赖肠外营养（P = 0.002）。在重新吻合前实现肠内自主的婴儿，胆汁淤积的发生率较低（P = 0.038），生长速度较快（P = 0.02）。
少数患有 SBS 和肠造口的 LBW 婴儿在重新吻合前实现了肠内自主。远端造口（回肠造口和结肠造口）、减少胆汁淤积和更好的生长与肠内自主的实现相关。我们的报告强调了在 IF 和肠造口的 LBW 婴儿中建立肠内自主的挑战，以及少数患者采用该方法的可行性，并带来了切实的益处。
