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Table 3 Demographic characteristics of individual clinical trials included in this review

From: The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic review

Studies Participants (Age) Interventions Results
Pierro, van Saene, Jones et al. (1998) [18] 94 infants on PN (median age 37 weeks) 94 infants were on TPN. Throat and rectal swabs (surveillance cultures) were obtained before and twice a week after TPN started. Cefotaxime and metronidazole were given for prophylaxis, then blind therapy with a combination of Gentamicin and teicoplanic was given at the onset of sepsis. Blood cultures (central/peripheral) were sent. 41 patients (44%) on PN for 30 days, developed abnormal carriage. Among these carriers, 2 infants developed oropharyngeal E. Coli followed by Klebsiella spp, enterobacter spp, and Pseudomonas aeruginosa. 9 infants had blood cultures positive with enterococci, E. Coli, Klebsiella, Candida, and coagulase (-) staphylococci.
Pierro, van Saene, Donnell et al. (1996) [17] 94 infants, median gestation was 37 weeks Surveillance cultures of oropharynx and gut were obtained at the start of TPN and thereafter twice a week. Blood cultures (central/peripheral) were sent. 15 infants developed sepsis. 10 patients experienced septicemia. 6 patients had bacterial translocation, and overgrowth of bacteria observed in 9 patients.
Andorsky et al. (2001) [96] Total of 30 infants with SBS (age <30 days) NEC = 13, Intestinal atresia = 9, Gastroschisis = 5, Malrotation/volvulus = 3 Median residual small bowel length was 61 cm. All infants were on TPN. The shortest duration of PN use was 101 days, and the longest was 3287 days, and median was 245 days. Of the 30 patients in the study, 20 (67%) were weaned from PN; 9 of the 10 TPN-dependent infants died from infection, cardiac arrest while receiving TPN.
Okada, Klein, van saene et al. (2000) [7] 41 babies enrolled (<4 mos. old). Gastroschisis = 11, (NEC) = 7, intestinal atresia = 3, diaphragmatic hernia = 2, esophageal atresia = 2, infant with no GI problems = 11, control infants = 5, and healthy adult volunteers (control) = 5. 5 infants receiving TPN for more than 10 days. 5 infants on normal enteral diet. Coagulase-negative staphylococci were added to whole blood from control patients receiving TPN. Body weight was significantly lower in patients receiving TPN. The blood from control group killed 65% of the coag-neg. Staph, while the blood from long term TPN group failed to kill this organism.
Okada, Klein, Pierro et al. (1999) [20] Surgical infants (NEC, gastroschisis)= 5, infants (control)= 5, healthy adults (control)= 5. 5 surgical infants on long term TPN (>10 days), 5 infants on normal enteral diet, 5 healthy adults. The percentage of bacteria killed by the neutrophils increased with time. However, the ability of killing was significantly lower in infants on TPN.
Okada, Papp, et al. (1999) [19] 5 enterally fed infants (age<6 mos), and 6 healthy adults Fasting blood samples: A) 10 ml normal saline (N/S) B) 0.1 ml TPN in 9.9 ml N/S C) 1 ml TPN in 9 ml N/S D) 10 ml TPN In infants, 1 ml of TPN in 1 ml blood produced a significant decrease in TNF-α production.
Weber (1995) [94] 21 infants and children with short bowel length (<80 cm) on TPN through central line. 20 infants without SBS (13 NEC, 4 atresia, 1 gastroschisis, 2 volvulus) had surgery No enteral feeding for 7 to 14 days during the post-op period. Blood cultures from central line and peripheral line were sent to identify the organism 6 patients had 8 separate episodes of sepsis before enteral feeding was began. After enteral feeding started, 16 patients had 67 episodes of bacteremia.
Chaet et al. (1994) [5] 32 children with SBS Gastroschisis = 3 Volvulus = 5, NEC = 8, Atresia = 8, Hirschprung's = 5 32 children with residual small bowel length <100 cm (range 14-94, median 40). All patients required TPN support for minimum 2 months. 10 patients were on TPN for>3 years. 4 patients died. Two of these deaths were from complications of TPN, and other 2 had pneumonia and respiratory failure secondary to broncho-pulmonary dysplasia. All four patients were TPN dependent up to the time of their deaths. One of these death patients bowel length was 30 cm and ICV was intact while the other did not (bowel length, 15 cm).
Kaufman et al. (1997). [98] 49 neonates with SBS, NEC = 20, Atresia = 12, Gastroschisis = 9, Volvulus = 8. Infants with SBS required TPN for more than 3 months after initial surgery. Oral feeding was permitted in small volumes. Patients went home with TPN. 42 patients were able to wean completely from TPN. Bacterial overgrowth was diagnosed in all 7 children who were receiving TPN. Occurrence of bacterial growth was related to small bowel length. 6 of them died.
Sondheimer et al. (1998) [97] 44 infants NEC = 14, Atresia = 6, Gastroschisis = 4 Volvulus = 2, unknown = 10 Almost half of 32 infants had 50% or more of the estimated intestinal length resection. The remaining 12 infants had 10-50% of bowel resection. Of the 44 patients, four patients have died from liver failure while on TPN. Seven patients depended on TPN from 40 to 129 months. The rest, 27 patients were off TPN after 36 months of age. Outcome of 10 patients unknown.
Bines et al. (1998). [95] 4 patients with SBS (6 months to 5 yrs), NEC = 2, Volvulus = 1 Hirschprung = 1 All patients had central line. Patients received pregestemil formula via continues GT, while on TPN, then study formula (Neocate) was given All patients were able to discontinued TPN within 15 months of initiating the study formula. After tolerating enteral study formula, morbidity and hospitalization reduced dramatically.
Rossi et al. (1993) [93] 7 children, ages 9 months to 17 years. 3 children with inflammatory bowel disease (IBD) were on TPN for one month. 4 children with SBS on TPN for 7 to 54 months. 22 infants (control) on normal diet. All patients while on TPN for one month, underwent to intestinal endoscopy and biopsy. Of these patients: 7 on TPN, and had upper intestinal biopsy. 4 patients required TPN for >9 months Biopsies from patients in the IBD group didn't show atrophy. 3 patients on long-term TPN for SBS had very mild (grade I) villus atrophy.
Dahlstrome (unpublished, 1988) [90] 29 children (4–111 month) SBS = 11/9 on TPN/ PPN (small bowel<25 cm) pseudoobstruction = 7 on PPN immunodeficiency = 1 radiation enteritis = 1 28 (control) healthy children (10 USA and 18 Swedish the same age group) Group I children absorb <5% of their daily caloric intake; Group II children was 30-70%. Home-TPN was given each night, and children were encouraged to eat daytime as much as possible for an average of two years. After two years of long-term TPN, children had abnormal lymphocyte count, low levels of serum albumin and protein in-group I. Four children developed selenium deficiency, and 15 children on PN for 3 yrs had significantly low Hb and Hct compared to controls. Eleven of 29 children died from low lymphocyte count. Seven died (5 from SBS, 1 from pseudoobstruction, 1 from immune deficiency), 4 from TPN induced cholesistatic liver disease and from bacterial septicemia.
  1. PPP:Partial parenteral nutrition, PN: Parenteral nutrition, Hb: Hemoglobin, Hct: Hematocrit