Predicting time to full enteral nutrition in children after significant bowel resection

Purpose Parenteral nutrition (PN) contributes to considerable morbidity in children after significant bowel resection. This study evaluates the utility of clinical variables in predicting time to independence from PN. Methods After IRB approval, a retrospective review (1999–2012) of 71 children who were on PN for > 6 weeks after intestinal resection and successfully weaned was performed. Clinical characteristics were evaluated to determine the relationship to time to full enteral nutrition. P-values < 0.05 were significant. Results Most children had necrotizing enterocolitis (56%), intestinal atresia (20%), or gastroschisis (11%) with a median small bowel length of 55 cm (IQR, 35–92 cm). The duration of PN was independent of the etiology of intestinal loss, presence of the ileocecal valve or colon, or location of anastomosis, but was strongly associated with small bowel length (< 0.01) and percent of expected small bowel based on gestational age (GA) (median 50%, < 0.01). In general, children who had 25–50% of their small bowel were dependent on PN for at least 2 years compared to approximately 1 year for those with 51–75%. Conclusion The duration of PN dependence in children after major bowel resection is best predicted by remaining small bowel length and can be estimated using a linear regression model. Level of evidence 2b.