Nutrition Support for Pediatric Short Bowel Syndrome

Abstract

Short bowel syndrome (SBS) develops in infants and children with inadequate small intestine for digestion and absorption of enteral nutrients for normal growth and development. This can lead to malabsorption of macronutrients or micronutrients, electrolyte imbalance, dehydration, malnutrition, and growth failure. The goals of nutrition support in pediatric SBS are to promote intestinal adaptation, avoid complications associated with intestinal resection and parenteral nutrition (PN), and, ultimately, maintain normal growth. In the initial phase of SBS, PN support is important in order to meet energy requirements and for avoidance of electrolyte imbalance or dehydration. Enteral nutrition should be initiated as soon as possible after bowel resection in order to promote intestinal adaptation. In order to stimulate oral motor activity and to avoid feeding aversion behavior, tolerable volumes of bottle-feeding or solid food should be accepted. In addition, feeding volume might be gradually increased in small amounts with monitoring of stool quantity and consistency. Because not all enterally administered calories are absorbed, PN should not be decreased isocalorically against enteral nutrition. In order to enhance bowel adaptation by maximizing nutrient delivery, it is necessary to determine the potential advantages of administration mode, continuous vs. bolus feeding, and what formula should be considered, polymeric vs. monomeric or oligomeric formula. Optimal enteral feeding regimen for pediatric SBS is still being debated, how to feed or what to feed, therefore, nutritional management of SBS should be adjusted according to the patient’s medical condition.