What is the incidence of short-gut syndrome after intestinal resection to treat necrotizing enterocolitis (NEC)?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Short-gut syndrome is the most serious postoperative complication in NEC, occurring in as many as 23% of patients after intestinal resection. This is a malabsorption syndrome resulting from the removal of excessive or critical portions of small bowel necessary for absorption of essential nutrients from the intestinal lumen.

Symptoms are most profound in babies who either have lost most of their small bowel or have lost a smaller portion that includes the ileocecal valve. Loss of small bowel can result in malabsorption of nutrients, as well as of fluids and electrolytes.

The neonatal gut grows and adapts over time, but long-term studies suggest that this growth may take as long as 2 years to occur. During that time, maintenance of an anabolic and complete nutritional state is essential for the growth and development of the baby. This is achieved by parenteral provision of adequate vitamins, minerals, and calories; appropriate management of gastric acid hypersecretion; and monitoring for bacterial overgrowth. The addition of appropriate enteral feedings during this time is important for gut nourishment and remodeling.

Babies who can never successfully feed enterally and/or who develop life-threatening hyperalimentation liver disease may be candidates for organ transplantation. Centers specializing in neonatal and infant small bowel and liver transplantation may consider referrals on a case-by-case basis.


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