Management of short bowel syndrome in postoperative very low birth weight infants

Nutritional management of surgical newborns and infants in the acute phase and during follow up

“…Careful attention should also be paid to patients with severe malnutrition or additional losses (i.e., jejunostomy, ileostomy), who have particularly high protein requirements. 6,11,12 Energy intake during parenteral nutrition is provided by carbohydrates and lipids. The quantity of glucose that can be infused safely differs according to infants' clinical condition and maturity.…”

“…Accordingly, glucose intake exceeding 18 g/kg/day is not recommended in stable surgical newborns receiving parenteral nutrition. 6,11,12 Lipid emulsions are an essential part of parenteral nutrition, both as an energy supply delivered as an iso-osmolar solution at a low volume, both as a source of essential fatty acids, even though their long-term use has been associated with the development of cholestasis, cholelithiasis, hepatic steatosis and hepatic fibrosis. Liver disease may progress to biliary cirrhosis and portal hypertension (intestinal failure-associated liver disease, IFALD).…”

“…If sodium losses are not adequately replaced, compensatory hyperaldosteronism can arise, and as a result, an increase in urinary potassium loss can occur. 11,12 Although parenteral nutrition is of major importance for the management of surgical infants when there is need to bypass the gastrointestinal tract to provide nutrition and fluids, its use is associated with significant complications, such as the previously mentioned intestinal failure-associated liver disease, catheter malfunction and the development of catheter-related bloodstream infections and/or thrombosis. Hence, parenteral nutrition volume should be gradually reduced to discontinuation as soon as a slow and carefully monitored enteral nutrition approach can be implemented.…”

“…The use of human milk-based fortifiers has been advocated so that infants can be fed an exclusive diet of human milk, which has been associated with more beneficial effects than feeding human milk fortified with cow's milk derived fortifiers. 12 If human milk is not available, there is a lack of consensus on whether a hydrolysed formula, either as extensively or partially hydrolysed formula, should be used as a first choice rather than intact cow's milk formula. 12,22,23 It has also to be taken into consideration that the use of hydrolysed formulas has been associated with faster gastric emptying and intestinal transit time, which may not be beneficial in infants who have undergone bowel length reduction.…”

“…12 If human milk is not available, there is a lack of consensus on whether a hydrolysed formula, either as extensively or partially hydrolysed formula, should be used as a first choice rather than intact cow's milk formula. 12,22,23 It has also to be taken into consideration that the use of hydrolysed formulas has been associated with faster gastric emptying and intestinal transit time, which may not be beneficial in infants who have undergone bowel length reduction. On the other hand, hydrolysed formulas have been reported to promote more efficient protein digestion, even though available data are not conclusive.…”