Factors Related to the Development of Small Bowel Bacterial Overgrowth in Pediatric Intestinal Failure
Bibliographic record
Abstract
Background: Small bowel bacterial overgrowth (SBBO) is a challenge in the management of pediatric intestinal failure (PIF). The development of SBBO may delay or prevent weaning of parenteral nutrition (PN) contributing to other complications. Our goal was to determine the proportion of patients treated for SBBO by an intestinal rehabilitation program and factors related to its development. Methods: A retrospective analysis of PIF patients referred between 2008–2014. Data was collected on factors related to IF and SBBO. Patients were also evaluated for refractory SBBO (use of 3 or more antimicrobial agents). Diagnosis of SBBO was based on clinical symptoms. Statistical testing completed using T-test, Chi square and logistic regression. Results: 35 of 102 patients followed by our (IRP) developed SBBO (34%) and 16 (16%) had refractory SBBO. Children with SBBO had an older gestational age (34.8 vs 32.3 weeks, p=0.01) and higher birth weight (2345 vs 1843g, p=0.001). Those with gastroschisis were more likely to develop SBBO (40.0 vs 19.4%, p=0.025). The development of SBBO was more likely in those with shorter percentage residual small bowel (SB) (45.4 vs 66.5%, p=0.004). Those with SBBO were more likely to have had a serial transverse enteroplasty (STEP) (22.9 vs 3.0%, p=0.004). Patients with SBBO were less likely to wean from parenteral nutrition (PN) (51.4 vs 85.1%, p < 0.0001). Similar to those with SBBO, refractory SBBO patients had a higher birth weight (2557 vs 1903g, p=0.007) and were likely to have gastroschisis (50.0 vs 22.1%, p=0.020). Refractory SBBO patients had shorter percentage small and large bowel remaining (23.2 vs 65.9%, p < 0.0001 and 60.6 vs 79.4%, p=0.03), more likely to have had a STEP procedure (50.0 vs 2.3%, p < 0.0001) and less likely to wean from PN (37.5 vs 80.2%, p=0.001). Logistic regression for development of SBBO demonstrated that longer small bowel residual was protective (p=0.001, OR 0.95; CI 0.93-0.99) and IF category (SBS) was as risk factor (p=0.001, OR 0.04; CI 0.01-0.27). The presence of an ileocecal valve (ICV), stoma and method of delivery (vaginal vs cesarian section) was not significant. Conclusion: SBBO has management challenges in PIF. A longer SB remnant was protective against the development of SBBO. Patients with SBBO were more likely to have a diagnosis of SBS and remain PN dependent. The presence of the ileocecal valve, stoma or method of delivery did not predict development of SBBO in our cohort.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".