Nutrition Management in Pediatric Small Bowel Transplant

Abstract

Fifty-five children received intestinal transplants (ITx) a t the Children's Hospital of Pittsburgh between July 1990 and January 1997. We assessed 23 children who had at least 1 year of follow-up with functioning intestinal grafts (7 isolated small bowel, 13 liver/ small bowel, and 3 multivisceral) for nutritional status, linear growth, and weight gain. We divided the children into 4 groups by age: infants <1 year (n = 41, toddlers 1-5 years (n = 61, preadolescents 5-10 years (n = 61, and adolescents 10-18 years (n = 7). We began an appropriate elemental formula at an average of 15 days post-ITx (median, 13 days). At l-year post-ITx, 15 children (65%) were thriving on oral diets, 7 children (31%) required enteral tube feedings that were secondary to oral aversion, and 1 child (4%) received partial parenteral nutrition support. Anthropometric data showed linear growth, appropriate weight in relation to height, and maintenance of fat and muscle stores. Serum albumin increased oneyear post-ITx in each age group. Serum zinc and red blood cell (RBC) folate levels were commonly found to be abnormal post-ITx. PREINTESTINAL TRANSPLANT EVALUATIONWe referred all candidates for intestinal transplant (ITx) to the Intestinal Care Center (ICC) of the Children's Hospital of Pittsburgh with a diagnosis of intestinal failure. Intestinal failure in children can be classified into one of two categories: anatomic or functional.' Anatomic causes of intestinal failure occur because of a decreased length of bowel after resection that is secondary to diseases such as midCorrespondence and reprint requests: Sharon L. Strohm, hIBA,

Pediatric Intestinal Transplantation—Review of Current Practice

“…The use of pancreatic enzymes has been reported to decrease stomal outputs and increase weight gain in the posttransplant period. 44 It is not uncommon for Tx patients to have poor gastric motility in the months after transplant. Prokinetic agents can be used to assist gastric emptying.…”

Enteral Formula Use in Children After Small Bowel Transplant

“…Formula feeding tolerance was evaluated by measures of stoma output and stool Clinitest (Bayer Corp, Elkhart, IN), hemoccults (Beckman Coulter, Palo Alto, CA), and pH. 9 Stool output that exceeded 40 mL/kg per day was generally treated with IV fluid replacement and a maintenance or reduction in formula volume. The electrolyte concentration of the fluid replacement solution was based on the electrolyte content of the stool and laboratory serum electrolyte values.…”

“…9 Favorable trends in linear growth, maintenance of muscle and fat stores, and successful transition to an oral diet without enteral or parenteral supplementation were reported. Although an elemental enteral formula with either an amino acidor peptide-based protein component is generally recommended for children with malabsorptive disorders including SBS, the formula composition of choice for children following ITx has yet to be determined.…”

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].…”