Enteral Formula Use in Children After Small Bowel Transplant

Abstract

The ultimate goal of intestinal transplantation (ITx) is the maintenance of nutritional status enterally/orally. We retrospectively identified children who had received ITx since the inception of our Intestinal Care Center in December 1996 (n = 24; median age, 2.6 years). Two patients died within 2 months of transplant. Enteral formulas used in the remaining 22 patients included the following: amino acid, trace long chain fatty acids (LCT; n = 4); amino acid, medium chain fatty acids (MCT)/LCT fat mix (n = 13); amino acid, LCT fat (n = 1); and peptide, MCT/LCT fat mix (n = 3). Feedings were initiated on an average of 13 days after ITx. The median number of days to complete the total parenteral nutrition (TPN) wean was 30 days, and stoma output measured on an average of 37 mL/kg per day at 1 month posttransplant. Nine patients (41%) advanced to oral intake alone within 2 to 30 months, and 5 patients (23%) were diagnosed with milk allergy through the RAST test (Pharmacia, Uppsala, Sweden). No differences in the initiation of therapy, advancement to oral intake, stoma output, or TPN weaning were observed by the type of formula used. Using z-score statistics, positive linear growth was achieved in 7 of 21 children (33%) over the 1-year period, whereas linear growth velocity was maintained in an additional 6 patients (29%). Successful advancement to total enteral/oral intake and positive growth after ITx can be achieved with either an amino acid- or peptide-based, partial MCT enteral formula initiated within 2 weeks of transplant. Monitoring for posttransplant allergy is recommended because of the high rate of postoperative allergy symptomology.

Clinical practice guidelines—Nursing management for pediatric patients with small bowel or multivisceral transplant

“…Limited research from single centers supports that the main goal of transplant is for the patient to be completely free of parenteral nutrition (Colomb & Goulet, ; Iyer et al., ; Nucci, Barksdale, Yaworski, Beserock, & Reyes, ; Weserman & Gilroy, ). According to Weserman and Gilroy (), parenteral nutrition should be reinitiated in the immediate postoperative period and continued until the patient can tolerate enteral feeds of at least 50% of their nutritional body requirements.…”

Nutritional Status After Intestinal Transplantation in Children

“…Maintenance of adequate growth in children with intestinal failure is usually impaired, due to malabsorption of electrolytes or nutrients, altered intestinal motility and oral aversion [13]. Prolonged use of total parenteral nutrition (TPN) improves the survival of these children, but it is usually associated with long-term complications like central line infections, lose of venous access or hepatic failure [1,7,9,12].…”

“…Intestinal transplantation (IT) has become a well described treatment for children with intestinal failure dependent on TPN or those in whom it fails [1,7,9,12].…”

Medium chain triglycerides (MCT) formulas in paediatric and allergological practice

“…These are patients with disturbed bile secretion (cholestasis, disturbances in hepatic-intestinal circulation of bile acids, intestinal dysbacteriosis), or pancreatic lipase secretion (for example, in pancreatic failure in the course of cystic fibrosis), since MCT do not have to be emulsified in the digestive tract or undergo the process of lipolysis [21–23]. Preparations containing MCT are also used in patients with disturbed absorption and energy deficiencies associated with, for example, classical coeliac disease, short bowel syndrome, or status post bowel transplantation [24–26]. …”