Short Bowel Syndrome in the NICU

Abstract

Short bowel syndrome (SBS) is the most common cause of intestinal failure in infants. In neonates and young infants, necrotizing enterocolitis, gastroschisis, intestinal atresia and intestinal malrotation/volvulus are the leading causes of SBS. Following an acute post-surgical phase, the residual gastrointestinal tract adapts with reorganization of the crypt-villus histoarchitecture and functional changes in nutrient absorption and motility. A cohesive, multidisciplinary approach can allow most neonates with SBS to transition to full enteral feeds and achieve normal growth and development. In this article, we review the clinical features, management, complications, and prognostic factors in SBS.

Clinical case and short review of extreme short bowel syndrome: an update 21 years after

“…Therefore the reported case is certainly of great interest in view of the patient's capacity to survive for many years after massive resection of the small intestine, despite several associated negative prognostic factors. 12,13 To our knowledge, previously studies have already reported cases of subjects with residual intestines of lengths ranging from 11 to 13 cm. who survived in good clinical condition, but in all these cases the ileocecal valve had been spared, and PN support could not be eliminated in most cases.…”

Nutritional management of surgical newborns and infants in the acute phase and during follow up

“…If sodium losses are not adequately replaced, compensatory hyperaldosteronism can arise, and as a result, an increase in urinary potassium loss can occur. 11,12 Although parenteral nutrition is of major importance for the management of surgical infants when there is need to bypass the gastrointestinal tract to provide nutrition and fluids, its use is associated with significant complications, such as the previously mentioned intestinal failure-associated liver disease, catheter malfunction and the development of catheter-related bloodstream infections and/or thrombosis. Hence, parenteral nutrition volume should be gradually reduced to discontinuation as soon as a slow and carefully monitored enteral nutrition approach can be implemented.…”

“…However, it must be taken into account that, in addition to the reduction of the intestinal length, impaired intestinal function may coexist, further contributing to inadequate absorption of enteral nutrients. 11,12,23,35 In Table 1 most common causes of short bowel syndrome in newborns and infants are indicated. The frequency of surgical short bowel syndrome was reported to be 0.7% among very low birth weight infants born during the period from 2002 to 2005 at the National Institute of Child Health and Development Neonatal Research Network Centres, and it showed an inverse relationship with birth weight.…”

“…Accordingly, glucose intake exceeding 18 g/kg/day is not recommended in stable surgical newborns receiving parenteral nutrition. 6,11,12 Lipid emulsions are an essential part of parenteral nutrition, both as an energy supply delivered as an iso-osmolar solution at a low volume, both as a source of essential fatty acids, even though their long-term use has been associated with the development of cholestasis, cholelithiasis, hepatic steatosis and hepatic fibrosis. Liver disease may progress to biliary cirrhosis and portal hypertension (intestinal failure-associated liver disease, IFALD).…”

“…Careful attention should also be paid to patients with severe malnutrition or additional losses (i.e., jejunostomy, ileostomy), who have particularly high protein requirements. 6,11,12 Energy intake during parenteral nutrition is provided by carbohydrates and lipids. The quantity of glucose that can be infused safely differs according to infants' clinical condition and maturity.…”