Nutritional management in a neonate with Short Bowel Syndrome: a case report from NICU, Tata Main Hospital, Jamshedpur

Asit Kumar Mishra

doi:10.25141/2476-2504-2017-1.0015

Abstract

Nutritional management in a neonate with Short Bowel Syndrome: a case report from NICU, Tata Main Hospital, Jamshedpur

Highlights

The most common cause of intestinal failure in neonatal intensive care unit (NICU) is surgical
Data from a Canadian tertiary NICU shows an overall occurrence of Short bowel syndrome (SBS) as 22.1 per 1000 admissions, and 24.5 per 100,000 live births, incidence being higher in infants born at less than 37 weeks gestation (353.7 per 100,000 live births) than in full-term infants (3.5/100,000 live births) [3].Necrotizing enterocolitis (NEC) is the most common cause of SBS (35%) in neonates, followed by intestinal atresia (25%), gastroschisis (18%), malrotation with volvulus (14%), followed by less common conditions such as Hirschsprung’s disease with proximal extension of aganglionosis into the small bowel (2%) [4]
The likelihood of developing SBS following bowel resection was greater when the residual intestinal length was less than 25% of the predicted length for a given gestational age [3].After surgery the clinical outcomes depend on areas of intestine lost to surgery

Summary

Introduction

The most common cause of intestinal failure in neonatal intensive care unit (NICU) is surgical. Baby was kept as probable volvulus / malrotation with sepsis, started on broad spectrum antibiotics as per our unit policy (cefoperazone-sulbactam and amikacin), oxygen, vitamin K, fluids and planned for X-ray chest and abdomen, urgent abdominal sonography. Post surgery baby was put on mechanical ventilator, started on total parenteral nutrition. Post operative days 3-7 remained uneventful when child had many spikes of fever, blood parameters showing high C reactive protein, high leukocyte count, dropping haemoglobin level and profound thrombocytopenia, previously placed central line was replaced with new one and antibiotic upgraded to meropenam and linezolid and fluconazole was added as blood culture showing growth of yeast. Child was discharged on calcium, multivitamins, ursodeoxycholic acid and domperidone in satisfactory condition on day 24 after surgery with regular follow-up schedule being handed over to parents

Findings

Discussion

Conclusion