Nutritional Management of Intestinal Failure due to Short Bowel Syndrome in Children

Abstract

Background: The most common cause of intestinal failure (IF) in childhood remains short bowel syndrome (SBS), where bowel mass is significantly reduced due to a congenital atresia or resection and parenteral nutrition (PN) needed. Home PN has improved outcome and quality of life, but the long-term therapeutic goal is to achieve enteral autonomy whilst avoiding long term complications. This paper is aimed at discussing nutritional strategies available to clinicians caring for these patients. Methods: A literature search was performed from 1992 to 2022 using Pubmed, MEDLINE and Cochrane Database of Systematic Reviews, and recent guidelines were reviewed. In the absence of evidence, recommendations reflect the authors’ expert opinion. Results: Consensus on the best possible way of feeding children with IF-SBS is lacking and practice varies widely between centres. Feeding should commence as soon as possible following surgery. Oral feeding is the preferred route and breast milk (BM) the first milk of choice in infants. Donor BM, standard preterm or term formula are alternatives in the absence of maternal BM. Extensively hydrolysed or amino acid-based feeds are used when these are not tolerated. Solids should be introduced as soon as clinically appropriate. Children are encouraged to eat by mouth and experience different tastes and textures to avoid oral aversion. Aggressive weaning of PN and tube (over-) feeding are now discouraged. Conclusions: To date, uniform agreement on the optimal type of feed, timing of food introduction and feeding regime used is lacking and great difference in practice remains. There is need for more research to establish common treatment protocols.

Nutritional management of high‐output ileostomies in paediatric patients is vital and more evidence‐based guidelines are needed

“…One study reported that the strongest correlation with shorter duration of parenteral nutrition needs in neonates with short bowel syndrome was seen with breast milk 40 . This is thought to be modulated by the presence of immunological factors such as immunoglobulin A, leucocytes and nucleotides, anti‐inflammatory cytokines, growth‐factors, human milk oligosaccharides and microbiota 41,42 . Pasteurised donor breast milk has been increasingly used for preterm infants when maternal breast milk was not available.…”

The use of amino acid formulas in pediatric patients with allergy to cow’s milk proteins: Recommendations from a group of experts

“…On the other hand, it has been shown that the presence of nutrients in the intestinal lumen is a key factor promoting intestinal adaption and digestive autonomy, favoring the use of EHF, as it is more complex than AAF. Thus, some authors would recommend starting breastfeeding or even a formula with whole CMP, switching to an EHF if the previous one is not tolerated, and reserving the use of AAF if the EHF fails ( 81 , 82 ).…”

Successful One-stage Multiple Intestinal Anastomoses in a Newborn Allowing to Avoid Post-Resection Short Bowel Syndrome: A Case Report

“…Case Report ного состояния, дефицит питательных веществ и витаминов, плохая прибавка в весе [1,4]. Энтеральное питание в физиологическом объеме невозможно, что требует нутритивной поддержки с использованием длительного парентерального питания (ПП) и туннельных центральных венозных катетеров (ЦВК).…”

“…Основными проявлениями СКК и ХКН являются синдром мальабсорбции, белково-энергетическая недостаточность, нарушение баланса электролитов и кислотно-щелочного состояния, недостаточность микроэлементов и витаминов, задержка физического развития [4]. Адаптация кишечника после резекции представляет собой сложный физиологический процесс.…”