26 - Nutritional management of preterm infants with short bowel syndrome

Summary

Introduction

The Short Bowel Syndrome (SBS) is the loss of intestinal length and absorptive surface area due to surgical resection. The loss of this mucosal absorptive surface area results in malabsorption and rapid transit potentiating malnutrition, recurrent dehydration, and electrolyte abnormalities. The most common cause of SBS in preterm infants is necrotizing enterocolitis with extensive resection. Other causes include resection following congenital malformations such as midgut volvulus from malrotation, intestinal atresias, and gastroschisis. VLBW infants with SBS require total parenteral nutrition (TPN) to provide the essential nutrients to sustain life and promote growth. The remaining bowel may be insufficient in length and function to utilize enteral nutrition. More than 80% of infants and children survive after extensive small bowel resection in the neonatal period. Prognosis is related to adjusted intestinal length, the presence of an ileocecal valve, colon preservation and occurrence of cholestasis. Most of the deaths in patients with SBS are caused by liver failure or sepsis and occur during the first year of life. The time for which the infant is dependent on TPN is significantly influenced by the length of residual intestine and the absence of an ileocecal valve. The goal in the nutritional management of these infants is to gradually advance enteral nutrient delivery while the residual bowel adapts, and simultaneously weaning and discontinuing TPN while avoiding life-threatening liver disease. Ultimately the goal is for the infant to achieve normal growth and development by consuming an oral diet.