Objectives: Intestinal atresia is a common cause of intestinal obstruction in neonates. The predominant cause of late complications in these children is prolonged dependence on parenteral nutrition (PN). Our aims were to analyze the outcomes for patients with intestinal atresia at our institution, and to see how these changed with the implementation of an intestinal rehabilitation program (IRP).
Methods: This is a retrospective cohort study. The patient population is all children with intestinal atresias (118 patients) treated at our institution from July 2000 to June 2010, 20 of whom became PN dependent.
Results: Survival to hospital discharge was 95% for all patients, and 100% for those who had isolated atresia. Twenty of 118 patients (17%) were PN dependent beyond initial hospital discharge. At discharge, their median intestinal length was 22.5 cm, and they required PN for a mean of 88.5% of energy needs. Of these 20 patients, 2 died, 2 received transplants, and 2 transferred away for transplantation. The remaining 14 joined the IRP. Their mean energy requirement from PN is presently 10%, down from 87% at IRP enrollment, and 10 patients fully weaned off PN. Eleven of the 14 children had hyperbilirubinemia, with mean direct bilirubin of 7.5 mg/dL. All resolved their cholestasis during an average of 12 weeks.
Conclusions: These results compare favorably with those reported in earlier periods. With programs such as the IRP, patients with short bowel secondary to intestinal atresia can show improvement in liver function and nutritional parameters, and discontinue PN, avoiding the need for transplantation.
*Pediatric Residency Program
‡Intestinal Rehabilitation Program, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Address correspondence and reprint requests to Yevgeniya Nusinovich, Pediatric Residency Program, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (e-mail: firstname.lastname@example.org).
Received 28 March, 2012
Accepted 1 May, 2013
This study received grant support from the Research, Education, and Advocacy in Child Health program, part of the pediatric residency program at Children's National Medical Center.
The authors report no conflicts of interest.