3: Determinants of parenteral nutrition (PN) weaning in a pediatric cohort of short bowel syndrome (SBS) patients in the era of GLP-2 analogue treatment

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Introduction: SBS is the main cause of chronic intestinal failure. New treatments such as GLP-2 analogues aim at improving intestinal mucosal trophicity and absorption while reducing PN dependence. The aim was to identify the factors determining PN weaning in children with SBS. Methods: A monocentric retrospective study involved all SBS children followed between 2015 and 2020. PN dependence was defined as non-protein PN calories (kcal/day)/ REE (kcal/day, from Schofield). Statistical analysis included non-parametric tests, Mann-Whitney and Chi-2 for quantitative and qualitative variables respectively, and a multivariate Cox model. Results were expressed as median and IQR. Results: We included 137 patients with a median age at start of follow-up of 3.7 years (IQR 1.3-8.4). SBS types: 30% jejunostomy or ileo-rectal anastomosis (type 1), 41% jejuno-colic anastomosis (type 2) and 29 % jejuno-ileal anastomosis (type 3). The median length of the remaining SB was 50 cm (IQR 27-73). The main causes for SBS were: midgut volvulus (23.4%), necrotizing enterocolitis (22.6%), long-segment Hirschsprung disease (21.2%), gastroschisis (15.3%) and atresia (13.1%). The median PN dependence at inclusion was 104 % (IQR 80-122) and 83 % (IQR 50-111) at the end. Thirty patients received Teduglutide (TED) at 0.05mg/kg/day, from a median age of 8.5 yrs (IQR 7.2-11.0). The median treatment duration was 36 months (IQR 33-39); 27 patients were still treated at the end of follow-up. Fifty-five patients (40%) were weaned during the follow-up. Factors positively associated with PN weaning were: length of remaining SB (p<0.001) and TED treatment (p=0.05). Initial PN dependence was negatively associated with weaning (p<0.001), as well as SBS type 1 (p=0.04). Conclusion: As expected, SB length and the presence of colon were predictive factors for PN-weaning. Teduglutide becomes one of the factors positively associated with weaning. It should be considered in SBS but timing remains debated.

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