RESUMO
INTRODUCTION: SBS is the main cause of intestinal failure (IF) in children and has a high morbility and mortality. OBJECTIVES: to analyze factors associated with the outcome and survival of SBS children. METHODS: analytical, descriptive and retrospective study. We include patients with residual bowel length (RBL) ≤ 40 cm. OUTCOME is analyzed in groups: dead (D), adapted (A), parenteral nutrition dependant (NPD), and transplanted (Tx) according to: bowel anatomy, diagnosis, prematurely, year of beginning of IF, duration of IF, cholestasis (CB > 2 mg/dl) and thrombosis. Survival is analyzed with Kaplan Meier. RESULTS: 63 patients were included: RBL x 21 ± 11 cm, preserved colon 46%, prematures 41%, neonatal resection 78%, duration of IF x 0.66 years. 54% had cholestasis (CB x 5.29 ± 2.35 mg/dl) and 25% had thrombosis. OUTCOME: D 33%, A 27%, PND 30% and Tx 10%. Adapted patients had longer RBL (p 0.001) and more preserved colon (p 0.017). 1 year survival was 86%, 2 years 70% and 3 years 66%. Age at death: x 2.3 years. Causes of death: hepatic failure 62%, lack of venous access 19%, sepsis 10%, others 10%. Factors related to death were shorter RBL (p 0.045), cholestasis (0.049, admittance to the center before 2000 (p 0.02). CONCLUSIONS: SBS had a high mortality and 1/3 of patients could adapt requiring up to 5 years. Adaptation was in relation to anatomic factors. Mortality was related to.
Assuntos
Síndrome do Intestino Curto/terapia , Criança , Pré-Escolar , Colestase/complicações , Colestase/mortalidade , Colo/fisiologia , Humanos , Lactente , Recém-Nascido , Intestinos/patologia , Estimativa de Kaplan-Meier , Transplante de Órgãos , Nutrição Parenteral , Estudos Retrospectivos , Fatores de Risco , Síndrome do Intestino Curto/epidemiologia , Síndrome do Intestino Curto/mortalidade , Sobrevida , Trombose/etiologia , Trombose/mortalidade , Falha de Tratamento , Resultado do TratamentoRESUMO
INTRODUCTION: The intensive care of patients at home had probed important beneficialness for the patient and the Health System. There are very few experiences of this kind of care from the Public Hospitals. OBJECTIVE: To develop a social-sanitary analysis of the feasibility of the implementation of HPN on patients with short bowel syndrome (SBS) from a Public Hospital. MATERIAL AND METHODS: Patients hospitalized between 1985-2009 were included. We analyzed: age, residual intestine length (RIL), time between de indication and the beginning of HPN, HPN duration, treatment modality and clinical outcome. Social determinants: home place, habitat conditions, employment conditions, educational level, social security and Low Socioeconomic Status (LSS). The group were divided in two: 1- patients with feasibility of HPN when it was prescribed; 2- patients without feasibility of HPN. RESULTS: 61 patients were included, RIL x: 21.7 ± 11.6 cm. The HPN was feasible (G1) in 32 patients (52.4%) and no feasible (G2) in 29 (47.6%). The home treatment modality was in self-caring 25 (81%) and with nurses support 7 (19 %). The social determinants associated with the HPN feasibility were: more than one takecare (p 0.03), educational level (p 0.01), adequate habitat conditions (p 0.02) and Low Socioeconomis Status (LSS) (p 0.07). 17 patients reached intestinal adaptation (28%), 6 (10%) were transplanted, 19 (31%) died and 19 (31%) are actually on HPN. CONCLUSION: The HPN realized from the Public Hospital is feasible. Different social determinants were observed. The care of this group of patients must be done by an interdisciplinary group including general aspects of the child and the family.
Assuntos
Hospitais Públicos , Nutrição Parenteral no Domicílio/métodos , Cuidados Críticos , Escolaridade , Estudos de Viabilidade , Feminino , Humanos , Lactente , Recém-Nascido , Intestinos/anatomia & histologia , Intestinos/transplante , Masculino , Enfermeiras e Enfermeiros , Autocuidado , Síndrome do Intestino Curto/mortalidade , Síndrome do Intestino Curto/cirurgia , Síndrome do Intestino Curto/terapia , Classe SocialRESUMO
INTRODUCTION: SBS is a complex entity with high morbimortality. Survival following extent intestinal resection during the neonatal period is higher than 90%. Nutritional support is paramount during the periods of high growth. OBJECTIVE: To assess growth of children with neonatal SBS neonatal having received during the first two years of life. MATERIAL AND METHODS: A retrospective study was done on patients assisted at the Nutrition Department of the Children's Hospital of La Plata. The following parameters were gathered: gestational age (GA), diagnosis, length of the remnant bowel, liver impairment, duration of PN and EN, and socio-economical profile of the patients. Growth assessment was done by: weight (W), height (H) at two years (Control I), and at the last follow-up visit done at the Department (Control II), using the NCHS tables. Weight and height were expressed as the Z score (Z) and the percentage of W/H, and were related to need of long-term NS. Patients were categorized into three groups according to NS requirement at the time of Control II: PN-dependent, EN-dependent, and those not requiring nutritional support (WOS). RESULTS: Eighteen patients were included. Length of the remnant bowel was: 45 cm. (r 10-80 cm.), length was < 40 cm in 11 pts. (61%) (massive resection). The ileocecal valve was resected in 9 pts. (50%) and 3 pts. (16 %) required partial colon resection and 2 pts. (11%) total resection. Mean Z scores for W/A, H/A, %W/H, Z W/H yielded values < -2 SD, and the percentage of W/H appropriateness was > 90% in both controls. Twenty seven percent of the patients at two years of age, and 33% at the last control showed height < -2 SD. Two patients (11%) died while on PN from liver failure, both with 10 cm of remnant bowel and without VIC. At Control II, 4 patients (22%) remained PN-dependent. Mean length of the remnant bowel in this group was 33 cm (r: 17-50) and mean follow-up duration with PN was 2176 days (r: 750-4380). Six patients (33%) remained EN-dependent at Control II, with a mean intestinal length of 41 cm (r: 20-75) and 2 out of 6 pts. did not have VIC. This group of patients required PN as the initial therapy with a mean duration of 629 days. Follow-up time while on EN was 627 days (r: 210-3010). Six patients (33%) achieved nutritional support independence (WOS) with a mean intestinal length of 60 cm (r: 27-80) after a mean duration of NS of 791 days, being assisted with dietary recommendations and vitamins and minerals supplementation. The group showing the greatest growth impairment was the EN-dependent group since we consider that early withdrawal of PN was decided based on inappropriate socio-environmental conditions. CONCLUSIONS: According to the present study, we conclude that is may be possible to achieve a normal growth in children with neonatal SBS under nutritional support and that complications related to this nutritional therapy or difficulties for adequately implementing it at home may affect the final height.
Assuntos
Transtornos do Crescimento/etiologia , Complicações Pós-Operatórias/etiologia , Síndrome do Intestino Curto/complicações , Argentina/epidemiologia , Comorbidade , Nutrição Enteral , Feminino , Seguimentos , Gastroenteropatias/congênito , Gastroenteropatias/cirurgia , Idade Gestacional , Transtornos do Crescimento/epidemiologia , Humanos , Recém-Nascido , Icterícia Neonatal/epidemiologia , Fígado/fisiopatologia , Masculino , Estado Nutricional , Apoio Nutricional , Nutrição Parenteral , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Síndrome do Intestino Curto/epidemiologia , Síndrome do Intestino Curto/terapia , Fatores SocioeconômicosRESUMO
La colestasis (C) es una de las complicaciones más frecuentes en pacientes pediátricos con síndrome de intestino corto (SIC) dependientes de nutrición parenteral (NP). La etiología es multifactorial y la suspención de la NP asegura la resolución. Se deben implmentar medidas tendientes a minimizar la afectación hepática, principalmente en aquellos pacientes con dependencia de la NP. Objetivo: Análisis retrospectivo de las medidas que posiblitaron resolver la colestasis en niños con SIC bajo NP. Pacientes y métodos: se seleccionaron 15 niños con SIC que desarrollaron C por un tiempo no menor a un mes y la resolvieron sin suspender la NP. Se añalizaron: edad y longitud del intestino remanente, tiempo de NP al iniciar la C, número de infecciones y cirugías, duración de la C, uso de ácido ursodesoxicólico, ayuno, NP continua y cíclica. Se añalizaron en forma individual y asociados...