OBJECTIVES-The objective of this study was to determine the (1) incidence of short bowel syndrome in very low birth weight (<1500 g) infants, (2) associated morbidity and mortality during initial hospitalization, and (3) impact on short-term growth and nutrition in extremely low birth weight (<1000 g) infants.METHODS-Infants who were born from January 1, 20021, , through June 30, 2005, and enrolled in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Risk factors for developing short bowel syndrome as a result of partial bowel resection (surgical short bowel syndrome) and outcomes were evaluated for all neonates until hospital discharge, death, or 120 days. Extremely low birth weight survivors were further evaluated at 18 to 22 months' corrected age for feeding methods and growth.RESULTS-The incidence of surgical short bowel syndrome in this cohort of 12 316 very low birth weight infants was 0.7%. Necrotizing enterocolitis was the most common diagnosis associated with surgical short bowel syndrome. More very low birth weight infants with short bowel syndrome (20%) died during initial hospitalization than those without necrotizing enterocolitis or short bowel syndrome (12%) but fewer than the infants with surgical necrotizing enterocolitis without short bowel syndrome (53%). Among 5657 extremely low birth weight infants, the incidence of surgical short bowel syndrome was 1.1%. At 18 to 22 months, extremely low birth weight infants with short bowel syndrome were more likely to still require tube feeding (33%) and to have been rehospitalized (79%). Moreover, these infants had growth delay with shorter lengths and smaller head circumferences than infants without necrotizing enterocolitis or short bowel syndrome.CONCLUSIONS-Short bowel syndrome is rare in neonates but has a high mortality rate. At 18 to 22 months' corrected age, extremely low birth weight infants with short bowel syndrome were more likely to have growth failure than infants without short bowel syndrome. Copyright © 2008 by the American Academy of PediatricsAddress correspondence to Conrad R. Cole, MD, MPH, Emory University School of Medicine, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, 2015 Uppergate Dr, Atlanta, GA 30322. conrad_cole@oz.ped.emory.edu. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 April 1. SHORT BOWEL SYNDROME (SBS) is a devastating clinical problem that affects an estimated 20 000 Americans (children and adults). Although not consistently fatal, complications that are associated with this disorder include dehydration, malnutrition, sepsis, poor growth, and impaired neurodevelopment.1 -5 SBS is defined as insufficient bowel length to digest and absorb adequately nutrients that are needed to promote appropriate growth of the infant. SBS is often the result of massive small intestinal res...

Objective-This pilot study in parenteral nutrition (PN) dependent infants with short bowel syndrome (SBS) evaluated the impact of feeding route and intestinal permeability on bloodstream infection (BSI), small bowel bacterial overgrowth (SBBO) and systemic immune responses, and fecal calprotectin as a biomarker for SBBO.Study design-10 infants (ages 4.2-15.4 months) with SBS due to necrotizing enterocolitis were evaluated. Nutritional assessment, breath hydrogen testing, intestinal permeability, fecal calprotectin, serum flagellin-and LPS-specific antibody titers, and proinflammatory cytokine concentrations (TNF-α, IL-1 β, IL-6, IL-8) were performed at baseline, 60 and 120 days. Healthy, age-matched controls (n=5) were recruited.Results-BSI incidence was high (80%) and SBBO was common (50%). SBBO increased the odds for BSI (> 7-fold; p=0.009). Calprotectin levels were higher in children with SBS and SBBO versus those without SBBO and healthy controls (p<0.05). Serum TNF-α, was elevated at baseline versus controls. Serum TNF-α, IL-1 β, IL-6 and IL-8 levels diminished with increased enteral nutrition. Anti-flagellin and anti-LPS IgG levels in children with SBSwere lower versus controls and rose over time.Contact Information: Conrad R. Cole. M.D., M.P.H., M.Sc., Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta GA 30225, crcole@emory.edu, Phone: (404) Fax: (404) 727-4069. Edited by SL and WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-In children with SBS, SBBO increases the risk for BSI and systemic proinflammatory response decreases with increasing enteral feeding and weaning PN. NIH Public AccessShort bowel syndrome (SBS) is a rare but devastating clinical entity that is defined as a spectrum of diarrhea and malabsorption with associated complications (e.g. growth stunting, malnutrition) due to insufficient bowel length (1). In children, SBS is often the result of massive small bowel resection due to necrotizing enterocolitis (NEC) or major congenital gastrointestinal malformations (e.g. gastroschisis, intestinal atresia) (2). Recurrent bloodstream infections (BSI) and small bowel bacterial overgrowth (SBBO) are believed to be common complications associated with pediatric SBS, though only limited data are available (2,3). We recently reported that BSI and malnutrition were the most frequent indication for readmission of very low birth weight infants with SBS (2). Inpatient admissions account for majority of the cost of care in pediatric...

ClinicalTrials.gov:NCT01952080; EudraCT: 2013-004588-30.

Objective Leptin was discovered in 1994 as a hormone produced by adipose tissue with a modulatory effect on feeding behavior and weight control. Recently, the stomach has been identified as an important source of leptin and growing evidence has shown diverse functions for leptin in the gastrointestinal tract. Methods Using leptin as a keyword in PubMed, more than 17 000 articles were identified, of which more than 500 articles were related to the role of leptin in the gastrointestinal tract. Available abstracts were reviewed and more than 200 original articles were reviewed in detail. Results The available literature demonstrated that leptin can modulate several important functions of the gastrointestinal tract. Leptin interacts with the vagus nerve and cholecystokinin to delay gastric emptying and has a complex effect on motility of the small bowel. Leptin modulates absorption of macronutrients in the gastrointestinal tract differentially in physiologic and pathologic states. In physiologic states, exogenous leptin has been shown to decrease carbohydrate absorption and to increase the absorption of small peptides by the PepT1 di-/tripeptide transporter. In certain pathologic states, leptin has been shown to increase absorption of carbohydrates, proteins, and fat. Leptin has been shown to be upregulated in the colonic mucosa in patients with inflammatory bowel disease. Leptin stimulates gut mucosal cell proliferation and inhibits apoptosis. These functions have led to speculation about the role of leptin in tumorigenesis in the gastrointestinal tract, which is complicated by the multiple immunoregulatory effects of leptin. Conclusion Leptin is an important modulator of major aspects of gastrointestinal tract functions, independent of its more well-described roles in appetite regulation and obesity.

Objective To determine the prevalence of specific micronutrient (iron, zinc, magnesium, phosphorus, selenium, copper, folate, vitamins A, D, E and B12) deficiencies in children with intestinal failure (IF), and identify risk factors associated with developing these deficiencies. Study design A retrospective review of prospectively collected data from 178 children with IF managed by the intestinal rehabilitation program at Cincinnati Children’s Hospital Medical Center, Ohio, USA between August1st 2007 and July 31st 2012. Transition to full enteral nutrition (FEN) was defined as the period during which the patient received between 20%–100% of estimated required nutrition enterally. FEN was defined as the patient tolerating all of the estimated required nutrition (100%) enterally for > 2 weeks. Results Necrotizing enterocolitis (NEC) was the most common cause of IF (27.5 %). Iron was the most common micronutrient deficiency identified during (83.9%) and after (61%) successful transition to FEN with significant reduction in the percentage of patients with iron deficiency between the two periods (P=0.003). Predictors of micronutrient deficiency after successful transition to FEN include birth weight (P=0.03), weight percentiles (P=0.02), height percentiles (P=0.04) and PN duration (P=0.013). After multivariate adjustments, only PN duration remained statistically significant (P=0.03). Conclusions Micronutrient deficiencies persist in patients with IF during and after transition to enteral nutrition. These data support the need for routine monitoring and supplementation of these patients especially those on prolonged PN.

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Sufficient evidence was noted showing that ethanol locks reduced CRBSIs and catheter replacements. Our findings raise questions about the effect of the ethanol lock on catheter integrity based on the noted increase in repair rate. This requires further prospective evaluation and may support selective application of ethanol locks to patients with documented CRBSIs.

Intestinal failure requires the placement and maintenance of a long-term central venous catheter for the provision of fluids and/or nutrients. Complications associated with this access contribute to significant morbidity and mortality, while the loss of access is an increasingly common reason for intestinal transplant referral. As more emphasis has been placed on the prevention of central line-associated bloodstream infections and new technologies have developed, care for central lines has improved; however, because care has evolved independently in local centers, care of central venous access varies significantly in this vulnerable population. The present position paper from the Intestinal Failure Special Interest Group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) reviews current evidence and provides recommendations for central line management in children with intestinal failure.