Effects of SBS and its management in paediatric patients

SBS and long-term parenteral support (PS) in children can be associated with multiple health issues and side effects.1,2

PS, in combination with little or no enteral feeding, premature birth, low birthweight, repeated catheter infections, and a lack of proper nutrition, may contribute to children developing liver disease related to SBS-IF.3 Liver disease is one of the primary causes of death in children with SBS.4

Children with SBS-IF also often have decreased overall growth and bone mineralisation.5

Quality of life

SBS-IF can have an important effect on the general well-being (quality of life) of children compared with healthy children, and these effects can potentially go well beyond the initial period of intestinal adaptation.6

While there are obvious effects on children with SBS-IF, the condition can also cause stress for the child's parents.7

The multidisciplinary team

Over recent years, multidisciplinary teams (MDTs) have been established to treat this disorder. MDTs are groups of healthcare professionals with different specialities who work as a team for the best treatment of the patient. The introduction of the MDT has led to a significant improvement in survival of patients with SBS and therefore should be used in centres where it is possible.8–10

The introduction of the MDT improved survival in patients with SBS8–10

References

  1. Javid PJ, Collier S, Richardson D, et al. The role of enteral nutrition in the reversal of parenteral nutrition-associated liver dysfunction in infants. J Pediatr Surg 2005;40:1015–1018
  2. Hess RA, Welch KB, Brown PI, et al. Survival outcomes of pediatric intestinal failure patients: analysis of factors contributing to improved survival over the past two decades. J Surg Res 2011;170:27–31
  3. Lacaille F, Gupte G, Colomb V, et al. Intestinal failure-associated liver disease: a position paper of the ESPGHAN Working Group of Intestinal Failure and Intestinal Transplantation. J Pediatr Gastroenterol Nutr 2015Feb;60(2):272–283
  4. Wales PW, de Silva N, Kim J, et al. Neonatal short bowel syndrome: population-based estimates of incidence and mortality rates. J Pediatr Surg2004;39:690–695
  5. Olieman JF, Penning C, Spoel M, et al. Long-term impact of infantile short bowel syndrome on nutritional status and growth. Br J Nutr 2012;107:1489–1497
  6. Olieman JF, Penning C, Poley MJ, et al. Impact of infantile short bowel syndrome on long-term health-related quality of life: a cross-sectional study. J Pediatr Surg 2012;47:1309–1316
  7. Mutanen A, Kosola S, Merras-Salmio L, et al. Long-term health-related quality of life of patients with pediatric onset intestinal failure.J Pediatr Surg2015;50:1854–1858
  8. Modi BP, Langer M, Ching YA, et al. Improved survival in a multidisciplinary short bowel syndrome program. J Pediatr Surg 2008;43:20–24
  9. Modi BP, Jaksic T. Pediatric intestinal failure and vascular access. Surg Clin North Am 2012;92:729–743
  10. Stanger JD, Oliveira C, Blackmore C, et al. The impact of multi-disciplinary intestinal rehabilitation programs on the outcome of pediatric patients with intestinal failure: a systematic review and meta-analysis. J Pediatr Surg 2013;48:983–992.

     

     

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