Very low birth weight preterm infants with surgical short bowel syndrome: incidence, morbidity and mortality, and growth outcomes at 18 to 22 months

Abstract

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.

FIGURE 1

Estimated time to in-hospital death for infants 401 to 1500 g birth weight. Differences in the survival distributions were significant (P < .001). Survival rates at 120 days were as follows: surgical SBS, 95% (n = 75); surgical NEC without SBS, 49% (n = 125); medical NEC, 78% (n = 68); no NEC or SBS, 86% (n = 903).

FIGURE 2

Types of food consumed by ELBW infants at 18 to 22 months’ corrected age (n = 2159). There was a significant difference between the groups in the usual diet reported (P < .001).

FIGURE 3

z scores for anthropometric measurements obtained from ELBW infants at 18 to 22 months’ corrected age (n weight = 3650, n length = 3636, n head circumference = 3645). Scores were significantly lower for infants with surgical SBS than for infants with medical NEC and no NEC or SBS on length (P < 0.01 for each) and head circumference (P < .05 and P < 0.01, respectively).