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. 2015 Jul;167(1):35-40.e1.
doi: 10.1016/j.jpeds.2015.02.053. Epub 2015 Apr 1.

Necrotizing Enterocolitis and Central Line Associated Blood Stream Infection Are Predictors of Growth Outcomes in Infants with Short Bowel Syndrome

Bram P Raphael  1 , Paul D Mitchell  2 , Darryl Finkton  3 , Hongyu Jiang  2 , Tom Jaksic  4 , Christopher Duggan  5
Affiliations

Necrotizing Enterocolitis and Central Line Associated Blood Stream Infection Are Predictors of Growth Outcomes in Infants with Short Bowel Syndrome

Bram P Raphael et al. J Pediatr. 2015 Jul.

Abstract

Objectives: To describe the natural history of growth patterns and nutritional support in a cohort of infants with short bowel syndrome (SBS), and to characterize risk factors for suboptimal growth.

Study design: A retrospective chart review of 51 infants with SBS followed by our intestinal rehabilitation program. Weight and length data were converted to age, sex, and gestational age-standardized weight-for-age z-scores (WAZ) and length-for-age z-scores (LAZ).

Results: Median (IQR) age at enrollment was 8.3 (0.9-14.6) weeks, and follow-up duration was 10 (8-13) months, including both inpatient and outpatient visits. Both WAZ and LAZ followed a U-shaped curve, with median for newborns (WAZ = -0.28; LAZ = -0.41), a nadir at age 6 months (-2.38 and -2.18), and near recovery by age 1 year (-0.72 and -0.76). Using multivariable regression analysis, diagnosis of necrotizing enterocolitis was independently associated with significant decrements of WAZ (-0.76 ± 0.32; P = .02) and LAZ (-1.24 ± 0.32; P = .0001). ≥ 2 central line-associated bloodstream infections was also independently associated with decreases in WAZ (-0.95 ± 0.33; P = .004) and LAZ (-0.86 ± 0.32; P = .007).

Conclusion: In a cohort of infants with SBS, we observed a unique pattern of somatic growth, with concomitant deceleration of both WAZ and LAZ and near recovery by 1 year. Inflammatory conditions (necrotizing enterocolitis and central line-associated bloodstream infections) represent potentially modifiable risk factors for suboptimal somatic growth.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Median parenteral and enteral energy intake in 51 infants (1129 follow-up observations) with surgical short bowel syndrome over the first year of life.
Figure 2
Figure 2
Weight- and length-for-age Z-scores in 51 infants (1125 WAZ follow-up observations; 512 LAZ follow-up observations) with surgical short bowel syndrome over the first year of life. Shown is the fitted regression curve superimposed over median (IQR) at each week of age.
Figure 3
Figure 3
All visits for each subject, with a closed dot (●) indicating on PN, and an open circle (○) indicating off PN. Subjects are ordered by decreasing time in the study.
Figure 4
Figure 4
Weight-for-length Z-scores in 51 infants (391 WLZ follow-up observations) with surgical short bowel syndrome over the first year of life. Weight-for-length Z-scores are unavailable for preterm infants. Shown is the fitted regression curve superimposed over median (IQR) at each week of age.
Figure 5
Figure 5
Weight- and length-for-age Z-scores restricted to 22 infants (570 WAZ follow-up observations; 249 LAZ follow-up observations) with surgical short bowel syndrome over the first year of life. Shown is the fitted regression curve superimposed over median (IQR) at each week of age.
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References

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