SUCCESSFUL USE OF A LIPID PREDOMINANT FORMULA IN CHILDREN WITH SHORT BOWEL SYNDROME

Abstract

61 Children with short bowel syndrome (SBS) are surviving longer as techniques of enteral feeding become increasingly sophisticated. Previously, success in weaning from total parenteral nutrition (TPN) was thought to be primarily related to length of remaining small bowel. Recently, however, other factors such as the presence of small bowel bacterial overgrowth (SBBO) and enteritis have been found to prolong the duration of TPN. Choice of enteral formula remains a point of controversy in the care of children with SBS. Formulas varying from completely elemental components to whole protein diets have been shown to be effective. It is agreed that regardless of formula type, aggressive use of any enteral formula is beneficial in weaning children with SBS from TPN. Our center routinely uses amino acid and/or hydrolysate formulas when initially feeding a TPN-dependent infant with SBS (those with <50 cm of small bowel). As these children grow, increasing problems with SBBO have hampered attempts to wean them from TPN. Five children with SBS (mean age 63.8 months) received a high fat, whole protein, calorically dense formula (Pulmocare®) after reaching a plateau in enteral advancement (55% ± 15% of total caloric needs). These patients reached full caloric requirements by the enteral route in 8.2 ± 1.8 months. Two were experiencing frequent hospitalizations for D-lactic acidosis unresponsive to standard broad spectrum antibiotics which abated with Pulmocare®. Both eventually weaned from TPN and demonstrated improved weight gain. No apparent side effects were noted using this formula. We postulate that the removal of excess carbohydrate substrate for bacterial metabolism from the enteral feeding, the trophic effects of fat, and reduced osmotic load were primary factors in ultimately permitting weaning from TPN.