Pediatric Intestinal Transplantation—Review of Current Practice

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.…”

“…When normal bowel mucosa is confirmed through biopsy, enteral nutrition can begin as early as 5–7 days postoperatively (Colomb & Goulet, ; James & Gupte, ). There are no data to support the best time to transition from continuous to bolus enteral feeds, although it is a widely accepted opinion that the discontinuation of continuous feeds allows for increased oral intake (Iyer et al., ). The rate at which enteral feeds are increased is based on the experience of the transplant center, as studies do not exist on this topic.…”

“…The rate at which enteral feeds are increased is based on the experience of the transplant center, as studies do not exist on this topic. Weight and strict documentation of intake and output should be monitored daily (Iyer et al., ). Ostomy output greater than 50 mL/kg/day often warrants decreasing feeding rate or changing formula, as the cause can be nutritional or medical (Iyer et al., ).…”

“…Weight and strict documentation of intake and output should be monitored daily (Iyer et al., ). Ostomy output greater than 50 mL/kg/day often warrants decreasing feeding rate or changing formula, as the cause can be nutritional or medical (Iyer et al., ). Parental education surrounding the patient's oral intake at home should be initiated shortly after transplant.…”

Nutrition Management of Small Bowel Transplant Patients

“…Typically, this is 5-7 days after transplant. 7,29 If the transplant recipient has had a gastrostomy feeding tube before transplant, often this tube will remain to allow for enteral feedings in the posttransplant course; otherwise, a nasojejunal feeding tube may be placed when enteral feedings are ready to be started. A low-fat, moderate osmolality, elemental formula is generally started at full strength and low rate of 10 mL/h continuously in adults.…”