Nutritional Management of Infants with Short Bowel Syndrome

Wessel, Jacqueline; Kocoshis, Samuel A.

doi:10.1053/j.semperi.2007.02.009

Cited by 111 publications

(91 citation statements)

References 85 publications

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“…These infants often remain dependent on parenteral nutrition (PN) for survival and growth. However, prolonged PN has been associated with serious complications, including nutritional deficiencies, risks secondary to central venous catheters and PN-associated cholestasis (PNAC) [1,2]. Neonatal PNAC is characterised by intrahepatic cholestasis and liver fibrosis and in severe cases can result in liver failure, with corresponding derangement in liver function, including raised plasma-conjugated bilirubin (CBil) and alanine aminotransferase (ALT) [3].…”

Section: Introductionmentioning

confidence: 99%

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A Double-Blind Randomised Controlled Trial of Fish Oil-Based versus Soy-Based Lipid Preparations in the Treatment of Infants with Parenteral Nutrition-Associated Cholestasis

Lam

Tam²,

Poon³

et al. 2014

Neonatology

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Background: Infants receiving prolonged parenteral nutrition (PN) are at risk of PN-associated cholestasis (PNAC). This can progress to hepatic failure and death if PN cannot be discontinued. Fish oil-based parenteral lipid preparation (FOLP) has been shown to be beneficial in case studies. Objectives: (1) To evaluate whether FOLP could halt or reverse the progression of PNAC compared with soy-based parenteral lipid preparation (SLP) and (2) to assess the effects of FOLP on liver function and physical growth. Methods: Design: double-blind randomised controlled trial. Setting: level III neonatal intensive care unit. Participants: infants with PNAC (plasma-conjugated bilirubin concentration ≥34 µmol/l or 2 mg/dl) expected to be PN-dependent for >2 weeks. Intervention: to receive either FOLP or SLP at 1.5 g/kg/day. Primary outcome measure: reversal of PNAC within 4 months after commencement of lipid treatment; secondary outcomes: rate of change of weekly liver function tests, infant growth parameters, blood lipid profile and episodes of late-onset sepsis. Results: A total of 9 infants were randomised to the FOLP group and 7 to the SLP group. There was no significant difference in reversal of PNAC at 4 months between groups. Rates of increase of plasma-conjugated bilirubin and alanine aminotransferase in the SLP group were significantly greater than the FOLP group (13.5 vs. 0.6 µmol/l per week and 9.1 vs. 1.1 IU/l per week, respectively, p = 0.03). Increased enteral nutrition was associated with significant improvement of PNAC in infants receiving FOLP compared with SLP (-8.5 vs. -1.6 µmol/l per 10% increase in enteral nutrition, respectively). The study was terminated prematurely. Conclusions: progression of PNAC in PN-dependent infants can be halted by replacing SLP with FOLP and reversed by increasing the proportion of enteral nutrition in infants receiving FOLP. Replacement of SLP with FOLP in PN-dependent infants who develop PNAC may be considered.

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Section: Introductionmentioning

confidence: 99%

“…Advances in neonatal intensive care [1] have reduced morbidity and mortality of infants with short bowel syndrome and intestinal failure. These infants often remain dependent on parenteral nutrition (PN) for survival and growth.…”

Section: Introductionmentioning

confidence: 99%

A Double-Blind Randomised Controlled Trial of Fish Oil-Based versus Soy-Based Lipid Preparations in the Treatment of Infants with Parenteral Nutrition-Associated Cholestasis

Lam

Tam²,

Poon³

et al. 2014

Neonatology

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“…Stool output limits are set on a surrogate threshold of 40-50 ml/kg. 18 Because of high levels of electrolyte losses in the effluent (Table IV), which are dependent on the region of the ostomy, the patient may be at increased risk of electrolyte disturbances above this threshold. Higher ostomy output is accepted in some centres.…”

Section: How To Increase Enteral Feedsmentioning

confidence: 99%

The nutritional management of short bowel syndrome in a very low-birthweight neonate

Rossouw

2016

South African Journal of Clinical Nutrition

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“…Small-intestinal bacterial overgrowth seems to be the triggering phenomenon for SBS and may contribute to symptoms, mucosal injury and malnutrition (10) . Its occurrence relates to alterations in intestinal anatomy, motility and gastric acid secretion.…”

Section: Short Bowel Syndromementioning

confidence: 99%

Potential benefits of pro- and prebiotics on intestinal mucosal immunity and intestinal barrier in short bowel syndrome

et al. 2010

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The mechanism of impaired gut barrier function in patients with short bowel syndrome (SBS) is poorly understood and includes decreased intestinal motility leading to bacterial overgrowth, a reduction in gut-associated lymphoid tissue following the loss of intestinal length, inhibition of mucosal immunity of the small intestine by intravenous total parental nutrition, and changes in intestinal permeability to macromolecules. Novel therapeutic strategies (i.e. nutritive and surgical) have been introduced in order to prevent the establishment or improve the outcome of this prevalent disease. Pre-and probiotics as a nutritive supplement are already known to be very active in the intestinal tract (mainly in the colon) by maintaining a healthy gut microflora and influencing metabolic, trophic and protective mechanisms, such as the production of SCFA which influence epithelial cell metabolism, turnover and apoptosis. Probiotics have been recommended for patients suffering from SBS in order to decrease bacterial overgrowth and prevent bacterial translocation, two major mechanisms in the pathogenesis of SBS. The present review discusses the research available in the international literature, clinical and experimental, regarding probiotic supplementation for this complicated group of patients based on the clinical spectrum and pathophysiological aspects of the syndrome. The clinical data that were collected for the purposes of the present review suggest that it is difficult to correctly characterise probiotics as a preventive or therapeutic measure. It is very challenging after all to examine the relationship of the bacterial flora, the intestinal barrier and the probiotics as, according to the latest knowledge, demonstrate an interesting interaction.

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Nutritional Management of Infants with Short Bowel Syndrome

Cited by 111 publications

References 85 publications

A Double-Blind Randomised Controlled Trial of Fish Oil-Based versus Soy-Based Lipid Preparations in the Treatment of Infants with Parenteral Nutrition-Associated Cholestasis

A Double-Blind Randomised Controlled Trial of Fish Oil-Based versus Soy-Based Lipid Preparations in the Treatment of Infants with Parenteral Nutrition-Associated Cholestasis

The nutritional management of short bowel syndrome in a very low-birthweight neonate

Potential benefits of pro- and prebiotics on intestinal mucosal immunity and intestinal barrier in short bowel syndrome

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