Pediatric Feeding Disorder in Children With Short Bowel Syndrome

Abstract

Objective: We aimed to characterize the prevalence of pediatric feeding disorder (PFD) in short bowel syndrome (SBS) and study factors contributing to the persistence of PFD. Methods: Single-center retrospective study of patients diagnosed with SBS at age 6 months or younger. Data were collected in 3-month intervals through age 2 years, and every 6 months through age 4 years. Demographic information, anthropometric data, and details regarding nutrition support were recorded and analyzed. Results: We reviewed 28 patients. Of the 21 patients who were weaned off parenteral nutrition, 57.1%, 81.0%, 90.5%, and 100.0% achieved this by 12, 24, 36, and 48 months of age, respectively. Of the 13 patients who were weaned off enteral nutrition, 30.8%, 69.2%, 76.9%, and 100.0% achieved this by 12, 24, 36, and 48 months, respectively. Discussion: The prevalence of PFD was 100.0%, 76.5%, 68.8%, and 70.0% at 1, 2, 3, and 4 years of age, respectively. All patients who exhibited resolution of PFD had an underlying etiology of necrotizing enterocolitis. Median small bowel percentage remaining was greater in patients who exhibited resolution of PFD compared to those who did not. Except for the group of patients seen at 4 years of age, a larger percentage of patients with vomiting/history of requirement of postpyloric feeds were seen among patients with PFD compared to those without PFD. Conclusion: PFD is prevalent in children with SBS. Although prevalence decreases over time, children with PFD will continue to require more medical attention than children that do not.

A Cross-Sectional Study of Pediatric Feeding Disorder in Children with Cystic Fibrosis

“…The rates of PFD are higher in children with other chronic diseases like short bowel syndrome and children with tracheostomy (20,21). Overall, PFD criteria were met by nearly 2 out of 3 children with CF in our study.…”

Factors Affecting the Gut Microbiome in Pediatric Intestinal Failure

“…Many patients with PIF are unable to tolerate feeds for prolonged periods of time, especially after recent surgical intervention, which can lead to intestinal atrophy and contribute to or potentially worsen dysbiosis. PIF is also associated with an increased risk of pediatric feeding disorder, thus requiring use of enteral feeds, often with elemental formulas based on institutional preferences (17). Etiology of PIF can also affect the ability for remaining intestine to adapt.…”

“…Early microbial composition is heavily comprised of a single taxonomic group, which then diversifies as solid feeds are introduced. Because feeding difficulties abound in PIF, particularly with consistent oral/ enteral feed exposure (17), one of the consequences might be a delay in the normal diversification of gut microbiome. Although our study did not show a significant difference in alpha diversity at the phylum level, it increased with age at genus level.…”

Evaluation and Management of Iron Deficiency in Children Undergoing Intestinal Rehabilitation—A Position Paper From the NASPGHAN Intestinal Rehabilitation Special Interest Group

“…ID is less common in children who eat meat than in children who are vegetarian, perhaps due to absorption of iron through heme (68). In children undergoing IR, dietary treatments may have limited appeal as the high prevalence of feeding disorders and restricted diets may limit intake (41). However, in qualitative studies, some families whose children do have enteral tolerance have expressed a desire to pursue this option (69).…”

“…Pediatric feeding disorder is common in children with IF (41). Some children are limited in their tolerance of meat, iron‐rich green vegetables, and seeds.…”