Outcomes of a novel pediatric intestinal rehabilitation program for children with short bowel syndrome: a retrospective cohort study

Background: Pediatric short bowel syndrome (SBS) is a severe cause of intestinal failure, often requiring prolonged parenteral nutrition (PN) and exposing children to sepsis and intestinal failure–associated liver disease (IFALD). In 2018, our institution established a multidisciplinary Pediatric Intestinal Rehabilitation Program (IRP) to optimize medical, nutritional, and surgical care. Methods: We performed a retrospective cohort study of children with anatomic SBS managed within our IRP (Meyer Children’s Hospital, Florence) between 2018 and 2024. SBS was defined as PN dependence for > 60 consecutive days. Data included demographics, SBS etiology and anatomy, major interventions (including autologous bowel lengthening: SILT/LILT/STEP), central line infections, IFALD, survival, enteral autonomy (complete PN discontinuation with adequate growth), and PN volume trends. Results: Forty-nine patients met inclusion criteria; 21 underwent bowel lengthening at our center. In this surgical subgroup, survival was 100% at last follow-up and no patient required intestinal transplantation. Seven of 21 children (33.3%) achieved enteral autonomy during follow-up. PN requirements decreased over time across techniques, with an overall PN volume reduction of 42.3% at 48 months (p < 0.05). SILT and LILT were associated with significant post-operative increases in bowel length and decreases in bowel diameter, whereas STEP showed non-significant length gains. Conclusions: Early outcomes from a newly established IRP show excellent survival, meaningful PN reduction, and no need for transplant in a high-risk pediatric SBS population, supporting the effectiveness and scalability of structured multidisciplinary intestinal rehabilitation.