Innovative parenteral and enteral nutrition therapy for intestinal failure

Abstract

Children with intestinal failure suffer from insufficient intestinal length or function, making them dependent on parenteral nutrition (PN) for growth and survival. PN and its components are associated with many complications ranging from simple electrolyte abnormalities to life-threatening PNassociated liver disease, which is also called intestinal failure-associated liver disease (ILALD). From a nutrition perspective, the ultimate goal is to provide adequate caloric requirements and make the transition from PN to full enteral Nutrition (EN) successful. Upon review of the literature, we have summarized the most effective and innovative PN and EN therapies for this patient population. Antibiotic-coated catheters and antibiotic or ethanol locks can be implemented, as they appear effective in reducing catheter-related infection and thus further reduce the risk of IFALD. Lipid emulsions should be given judiciously. The use of an omega-3 fatty acid-based formulation should be considered in patients who develop IFALD. Trophic feeding is important for intestinal adaptation, and EN should be initiated early to help wean patients from PN. Long term management of children with IF continues to be an emerging field. We have entered uncharted territory as more children survive complications of IF, including IFALD. Careful monitoring and individualized management to ensure maintenance of growth with avoidance of complications are the keys to successful patient outcomes.

Enteral nutrients potentiate glucagon-like peptide-2 action and reduce dependence on parenteral nutrition in a rat model of human intestinal failure

“…Several recent studies have highlighted the importance of trophic feeding to promote intestinal adaptation as mediated by intraluminal nutrients, gastrointestinal secretions, growth factors, and byproducts of digestions such as short-chain fatty acids (26,33,40,46,56). Several recent studies have highlighted the importance of trophic feeding to promote intestinal adaptation as mediated by intraluminal nutrients, gastrointestinal secretions, growth factors, and byproducts of digestions such as short-chain fatty acids (26,33,40,46,56).…”

Tarm- og flerorgantransplantasjon ved kronisk tarmsvikt

“…The insertion of a central venous catheter is necessary to provide assured access to the blood stream and is an absolute prerequisite for long-term TPN treatment. Bowel-lengthening surgery should be considered for children with short-bowel syndrome in order to determine which patients can stop using this type of nutrition, or possibly manage with intermittent treatment (6). The treatment may result in serious complications such as thrombosis of central veins, particularly if it lasts for months or years, and catheter infections may cause life-threatening sepsis.…”

Parenteral Nutrition-Associated Liver Disease in Pediatric Patients: Strategies for Treatment and Prevention

“…Even small, trophic volumes of feedings via continuous administration or small bolus amounts have shown clinical benefi t by reducing intestinal stasis and translocation of bacteria, improving bile fl ow, and avoiding oral aversion [ 23 ]. Trophic feeding exposes the intestinal tract to nutrient and hormonal stimulation which results in intestinal epithelial cell growth, enzyme activity, and motility [ 53 ]. Once tolerance to trophic feedings is established, advancing slowly toward caloric goal over a period of weeks to months may be achieved with a proportional decrease in PN administration, as clinically tolerated.…”