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

2015; Elsevier BV; Volume: 167; Issue: 1 Linguagem: Inglês

10.1016/j.jpeds.2015.02.053

1097-6833

Bram P. Raphael, Paul D. Mitchell, D Finkton, Hongyu Jiang, Tom Jaksic, Christopher Duggan,

Child Nutrition and Water Access

ObjectivesTo 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 designA 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).ResultsMedian (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).ConclusionIn 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. 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. 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). 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). 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.