Intestinal autonomy in extreme premature infants with short bowel syndrome: national experience

Abstract

Purpose: To investigate the outcomes of premature neonates with short bowel syndrome (SBS) managed under a BEAR (Bowel Elongation and Advanced Rehabilitation) protocol. Methods: This was a retrospective cohort study of preterm patients with SBS, treated at Sidra Medicine between January 2018 and February 2024. Data were extracted from electronic medical records, including patient demographics, clinical history, surgical interventions, parenteral nutrition (PN) duration, and long-term outcomes. The BEAR protocol incorporated a multidisciplinary approach with structured intestinal rehabilitation, hepato-protective PN strategies, and staged surgical interventions to promote enteral autonomy. Results: A total of 20 premature neonates with SBS were analyzed, with a median gestational age of 28 weeks and a median birth weight of 860g. Necrotizing enterocolitis was the primary cause of SBS in 90% of cases. Of the cohort, 80% successfully weaned off PN, achieving enteral autonomy at a median corrected age of 19.7 months. Seven patients underwent serial transverse enteroplasty (STEP), with 6/7 successfully transitioning to full enteral feeding. The study demonstrated favorable survival rates and reduced PN-associated complications. Conclusion: The BEAR protocol provides a structured and effective approach to intestinal rehabilitation in premature neonates with SBS, facilitating early enteral autonomy and minimizing long-term PN dependence. These findings contribute valuable clinical insights into optimizing multidisciplinary management strategies for this high-risk population.