Analysis of treatment outcomes of extensive bowel resections in newborns and infants

Objective. The outcomes of multiple intestinal resections in children may be accompanied by severe complications, including postresection short bowel syndrome (PSBS) and chronic intestinal failure (CIF). Such patients experience severe growth and developmental delays and often require long-term parenteral nutrition. Currently, a unified classification that could enable objective assessment of the risks of PSBS is lacking. The available approaches fail to account for the entire range of factors and are difficult to apply in clinical practice.

Materials and methods. In total, 80 patients with resections of various sections of the intestine were included in the study. Children with extensive resections were distinguished into a separate group (n = 42), with inclusion criteria being resection of more than one-third of one section or two or more sections of the intestine. The diagnostic criteria for PSBS were pathological intestinal stoma losses of 30 ml/kg/day or greater and a total stool and urine volume of 60 ml/kg/day or greater. The diagnostic criteria for CIF were prolonged parenteral nutrition with the inability to achieve enteral autonomy during the period of more than two months.

Results. Necrotizing enterocolitis and congenital malformations of the small intestine, including those associated with intestinal malrotation, were found to be the most common reasons for resection. Almost half of the cases accounted for ileum resections (42.7%), with the share of large bowel resections being 16.1%. In the extensive resection group (n = 42), resection of more than 2/3 of the jejunum statistically significantly resulted in the development of PSBS, while resection of more than 2/3 of the large bowel statistically significantly aggravated the prognosis. It was shown that PSBS developed in 60% of cases involving two sections of the intestine, amounting to 80% when three sections were involved. Resection of the ileocecal junction had no statistically significant effect on outcomes.

Conclusion. The currently available approaches to predicting outcomes after extensive bowel resections in children fail to take into account the entire range of nosologies, as well as intraoperative and postoperative criteria. Further analysis of the results obtained is needed to form a basis for developing a surgical classification for PSBS prediction. Such a classification will facilitate the process of decision making for surgeons and pediatricians involved in the treatment of children with PSBS and CIF.

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