Impact of Dietary Protein on the Management of Pediatric Short Bowel Syndrome

Abstract

Essential amino acids (AAs) play a key role in stimulating intestinal adaptation after massive small gut resection. The nutritional effect of dietary amino acids during intestinal regrowth has received considerable attention in recent years. This review explores the significance of dietary amino acids in the nutritional management of infants and children with intestinal failure and short bowel syndrome (SBS) as reported in the medical literature over the last three decades. A literature search was conducted using electronic databases. Breast milk emerged as the first-line enteral regimen recommended for infants with SBS. Hydrolyzed formulas (HFs) or amino acid formulas (AAFs) are recommended when breast milk is not available or if the infant cannot tolerate whole protein milk. The superiority of AAFs over HFs has never been demonstrated. Although glutamine (GLN) is the main fuel for enterocytes, GLN supplementation in infants with SBS showed no difference in the child’s dependence upon parenteral nutrition (PN). Circulating citrulline is considered a major determinant of survival and nutritional prognosis of SBS patients. Early enteral nutrition and dietary supplementation of AAs following bowel resection in children are essential for the development of intestinal adaptation, thereby eliminating the need for PN.

Ruptured giant omphalocele with congenital short small intestine: a case report

“…During the early intestinal maladaptation period, parenteral nutrition support is required to gradually enhance intestinal adaptation and achieve enteral autonomy, while avoiding complications such as intestinal failure-related liver disease and catheter-related bloodstream infections ( 15 , 31 ). Breast milk is the first choice for enteral nutrition for children with short bowel syndrome; however, when breast milk is not available, some scholars recommend the use of hydrolyzed or amino acid milk because children with short bowel syndrome are prone to cow’s milk protein allergy ( 32 , 33 ). Breast milk was unavailable; therefore, we chose extensively hydrolyzed formulas (eHF) combined with active parenteral nutrition for early trophoblastic feeding.…”