Pectin supplemented Enteral feedings in the treatment of short bowel syndrome in two infants

Abstract

Nutrition management following small bowel resection in neonates often involves prolonged periods of parenteral nutrition (PN) support with slow advancement of enteral feedings requiring a semi-elemental formula. While these formulas nurture the enterocytes of the proximal intestine, they provide little stimulation to the cells of the distal ileum and colon necessary to prevent malabsorption. The beneficial effects of short chained fatty acids (SCFA) on intestinal morphology and function in animals suggests potential for use of fermentable fiber in treatment of short bowel syndrome (SBS) in humans. We added 1–3% Certog liquid fruit pectin to the semi-elemental feeding of two former premature infants who had difficulty establishing enteral feeding tolerance following small bowel resection. Changes in absorption were directly measured by stool reducing substances and fecal fat content. Feeding tolerance, stool frequency, anthropometrics and serum electrolytes were also monitored. In the first patient we observed improvement in stool reducing substances from 3% to 0%, fecal fat loss from 21% to 10%, and resolution of metabolic acidosis within two weeks of adding pectin to the enteral formula. Feeding tolerance improved in both patients allowing for more rapid advancement of enteral support than previously attained and subsequent weaning of PN. Both patients maintained age appropriate growth velocity during this transitional phase. No deleterious effects associated with fiber supplementation such as tube occlusion, gastrointestinal obstruction or altered mineral absorption were observed. In summary, we found pectin supplementation to be safe and potentially beneficial in the enteral support of these two selected neonates with SBS.