In 1999, Children's Hospital Boston launched the Center for Advanced
Intestinal Rehabilitation (CAIR) to provide coordinated, multidisciplinary care for
children with short bowel syndrome (SBS). Now, a retrospective analysis finds that such care-integrating surgical, medical and nutritional management-is associated with significantly better survival.
Researchers led by Biren Modi, MD, a Rapapport Research surgical fellow in the CAIR program, compared 54 children with severe SBS, managed by CAIR from 1999 to 2006, with 30 patients treated between 1986 and 1998. Diagnoses included
necrotizing enterocolitis, intestinal atresia and gastroschisis. Survival was found to be 89 percent in the CAIR group, compared with 70 percent in the historical controls. Notably, among patients who remained on
parenteral nutrition, mortality was 33
percent in the CAIR group versus 90
Over the years, care of short bowel syndrome has improved with new measures, such as bowel lengthening procedures, transplantation and changes in parenteral nutrition solutions. But the program's multidisciplinary nature is key, say senior co-authors Christopher Duggan, MD, MPH, of the Division of Gastroenterology and Nutrition and Tom Jaksic, MD, PhD, of the Department of Surgery. CAIR's general surgeons,
gastroenterologists, transplant surgeons, nutritionists, pharmacists, nurses and social workers provide critical input on each patient's care regularly, allowing the team to make more timely and effective decisions, they say.
The study was published by the Journal of Pediatric Surgery in January.
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