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Factors Related to the Development of Small‐Bowel Bacterial Overgrowth in Pediatric Intestinal Failure: A Retrospective Cohort Study
Author(s) -
Belza Christina,
Betts Zachary,
Silva Nicole,
Avitzur Yaron,
Wales Paul W.
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1809
Subject(s) - medicine , gastroschisis , short bowel syndrome , parenteral nutrition , retrospective cohort study , gastroenterology , refractory (planetary science) , odds ratio , logistic regression , cohort , pregnancy , fetus , genetics , physics , astrobiology , biology
Abstract Background Small bowel bacterial overgrowth (SBBO) is a challenge in the management of pediatric intestinal failure (PIF). Our goal was to determine the proportion of patients treated for SBBO and factors related to its development. Methods We completed a retrospective analysis of PIF patients referred between 2008 and 2014. Data were collected on factors related to intestinal failure (IF) and SBBO. The cohort was stratified on the diagnosis of SBBO and refractory SBBO. Statistical testing completed using t ‐test, χ 2 test, and logistic regression. Results Thirty‐five of 102 patients developed SBBO (34%), and 16 (16%) had refractory SBBO. SBBO was more likely in gastroschisis (40.0% vs 19.4%, P = .025), a shorter residual small bowel (SB) (45.4% vs 66.5%, P = .004), and patients were less likely to wean from parenteral nutrition (PN) (51.4% vs 85.1%, P < .0001). Refractory SBBO patients were likely to have gastroschisis (50.0% vs 22.1%, P = .020) and a shorter residual SB and large bowel remaining (23.2% vs 65.9%, P < .0001 and 60.6% vs 79.4%, P = .03, respectively) and less likely to wean from PN (37.5% vs 80.2%, P = .001). Logistic regression demonstrated that longer SB residual was protective ( P = .001; odds ratio [OR], 0.95; 95% CI, 0.93–0.99), and short bowel syndrome (SBS) as a cause of IF was a risk factor ( P = .001; OR, 0.04; 95% CI, 0.01–0.27). Conclusion A longer SB remnant was protective against SBBO. Patients with SBBO were more likely to have PIF caused by SBS.