Does massive  bowel resection in newborns  affect further  immunity in children ?

Abstract

Background Short bowel syndrome (SBS) is defined as the a malabsorptive condition most often caused by massive resection of the small intestine. In children most cases of SBS originate in the newborn period and result from congenital anomalies or necrotizing enterocolitis. Loss of gut mucosa during resection does not only mean loss of absorption surface, but also deprives organism of many immunocompetent cells concentrated in gut associated lymphoid tissue, which is regarded the largest immune organ in humans. Aim of the study: We have aimed to access the influence of bowel resection on adaptive immunity in children, basing on peripheral lymphocyte populations and serum immunoglobulins. Patients and methods: 18 children, who underwent bowel resection in the first month of life and required further home parenteral nutrition were enrolled into the study. 12 healthy children, constituted control group. Based on flow cytometry the following subpopulations of lymphocytes were evaluated: T, B, NK, CD4+, C8 + and activated T cells. Serum immunoglobulins were determined with the use of immunoturbidimetric method. Results The percentage of B lymphocytes was reduced, while the rates of lymphocytes T and CD8 + lymphocytes were higher compared to healthy children. We documented significantly lower absolute count and proportion of NK cells in SBS group than in the control group. Absolute counts of lymphocytes, lymphocytes B, T, CD4 + and percentages of lymphocytes CD4+, and activated T cells inversely correlated with the time after resection. No statistically significant differences were found between the levels of IgA, IgM and IgG in the studied and the control group Conclusions Children with SBS do not present with clinical signs of immunodeficiency as well as deficits in peripheral lymphocyte populations and serum immunoglobulins. Lower number of NK cells in SBS patients compared to healthy children needs to be verified in larger cohort. The tendency of the lymphocyte subpopulations to decrease over time after resection points out the necessity for longer follow- up.