Soluble Fiber Use in Pediatric Short Bowel Syndrome: A Survey on Prevailing Practices

Harvie, Meredith Linley; Norris, Margaret Alyssa Tucker; Sevilla, Wednesday Marie A.

doi:10.1002/ncp.10089

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…Soluble fiber has been shown to be beneficial because it is fermented into short‐chain fatty acids, which can be metabolized by colonocytes for energy, decrease transit time, and add bulk to stools 50,55 . Various forms of fiber, such as the fiber in green beans, wheat dextrin, or guar gum, have been reported to treat high‐output and/or loose stools 50,56 . In a recent survey, 67% of clinicians used pectin, a water‐soluble fiber, as a treatment for increased stool output 56 .…”

Section: Definitionsmentioning

confidence: 99%

“…Various forms of fiber, such as the fiber in green beans, wheat dextrin, or guar gum, have been reported to treat high‐output and/or loose stools 50,56 . In a recent survey, 67% of clinicians used pectin, a water‐soluble fiber, as a treatment for increased stool output 56 . Fat modulars in the form of long‐chain or short‐chain triglycerides may be used, as they provide minimal change in the osmolality while providing additional energy.…”

Section: Definitionsmentioning

confidence: 99%

See 1 more Smart Citation

ASPEN definitions in pediatric intestinal failure

Modi

Galloway

Gura

et al. 2021

J Parenter Enteral Nutr

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Pediatric intestinal failure (PIF) is a relatively rare disease entity that requires focused interdisciplinary care and specialized nutrition management. There has long been a lack of consensus in the definition of key terms related to PIF because of its rarity and a plethora of small studies rather than large trials. As such, the American Society for Parenteral and Enteral Nutrition (ASPEN) PIF Section, composed of clinicians from a variety of disciplines caring for children with intestinal failure, is uniquely poised to provide insight into this definition void. This document is the product of an effort by the Section to create evidence‐based consensus definitions, with the goal of allowing for appropriate comparisons between clinical studies and measurement of long‐term patient outcomes. This paper has been approved by the ASPEN Board of Directors.

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Section: Definitionsmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

ASPEN definitions in pediatric intestinal failure

Modi

Galloway

Gura

et al. 2021

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…Dietary advice should promote a diet that is high in calories and proteins, low in insoluble fibres, moderate in fat, rich in complex carbohydrates and low in simple carbohydrates 14,21,54 . To increase stool consistency and decrease ostomy output, marshmallows and/or soluble fibres can be added to the diet 55–57,60 . Soluble fibres include partially hydrolysed guar gum, pectin, pectin‐rich foods such as green beans, sweet potatoes and bananas and wheat dextrin.…”

Section: Discussionmentioning

confidence: 99%

Nutritional management of high‐output ileostomies in paediatric patients is vital and more evidence‐based guidelines are needed

Awouters,

Vanuytsel,

Huysentruyt

et al. 2024

Acta Paediatrica

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AimPaediatric patients with high‐output ileostomies (HOI) face an elevated risk of complications. This study aimed to comprehensively review the existing literature and offer nutritional management recommendations for paediatric patients with an HOI.MethodsPubMed and Embase were searched for relevant English or French language papers up to 31 June 2022. The emphasis was placed on studies involving paediatric ileostomy patients, but insights were obtained from adult literature and other intestinal failure pathologies when these were lacking.ResultsWe identified 16 papers that addressed nutritional issues in paediatric ileostomy patients. Currently, no evidence supports a safe paediatric HOI threshold exceeding 20 mL/kg/day on two consecutive days. Paediatric HOI patients were at risk of dehydration, electrolyte disturbances, micronutrient deficiencies and growth failure. The primary dietary choice for neonates is bolus feeding with breastmilk. In older children, an enteral fluid restriction should be installed favouring isotonic or slightly hypotonic glucose‐electrolyte solutions. A diet that is high in calories, complex carbohydrates and proteins, low in insoluble fibre and simple carbohydrates, and moderate in fat is recommended.ConclusionAdequate nutritional management is crucial to prevent complications in children with an HOI. Further research is needed to establish more evidence‐based guidelines.

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“…Pectin is a soluble fiber that is an amylase‐resistant polysaccharide found in the cell wall of many fruits and vegetables. Pectin is commonly used to treat watery stool or high stool output in children with SBS >40 weeks corrected age 28 . Soluble fiber such as pectin that retain a gel and increase the viscosity of food may improve the consistency of watery or loose stools, resulting in a decrease in stool output.…”

Section: Discussionmentioning

confidence: 99%

“…Pectin is commonly used to treat watery stool or high stool output in children with SBS >40 weeks corrected age. 28 Soluble fiber such as pectin that retain a gel and increase the viscosity of food may improve the consistency of watery or loose stools, resulting in a decrease in stool output. This effect is particularly beneficial for an infant with SBS and a colon in continuity.…”

Section: First Foodsmentioning

confidence: 99%

Complementary food introduction practices in infants with intestinal failure

et al. 2022

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Background: Oral intake in infants with intestinal failure (IF) may be limited due to intolerance or feeding difficulties. Guidelines for the introduction of semisolid or solid complementary foods (CFs) to infants with IF do not exist.CF intake and caloric contribution from CF is difficult to assess due to malabsorption and incomplete recording. The aim of this study was to identify institutional approaches to introducing CF to infants with IF. Methods:The American Society for Parenteral and Enteral Nutriton (ASPEN) Pediatric Intestinal Failure Section Registered Dietitian/Nutritionist (RDN) working group designed a 10-question online cloud-based survey to assess group member practice related to the introduction of CF to infants with IF. Results: Twenty-six surveys were completed. Thirteen (50%) RDNs recommend introduction of CF between 4 and 6 months of age. Nineteen (76%) recommend adding pureed foods to gastrostomy tube feedings. Seventeen (65%) follow standard infant feeding practice guidelines with half citing the American Academy of Pediatrics. Approximately half (44%) recommend introducing vegetables first and the majority (80%) recommend delaying the introduction of fruits. The vast majority (92%) recommend specific foods to minimize stool output including green beans, bananas, infant cereals, and meats/protein. Conclusion: Institutional practices related to the introduction of CF to infants with IF vary. Similarities with first food choice and foods to avoid were observed. Evidenced-based practice guidelines for the introduction of CF to infants with IF need to be established to determine best practices for reducing stool output, encouraging weaning from parenteral nutrition, and achieving enteral autonomy.

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Soluble Fiber Use in Pediatric Short Bowel Syndrome: A Survey on Prevailing Practices

Abstract: The goal of the survey was to gather more information with regard to fiber use in the management of SBS patients. The data collected can be used to provide future direction on determining best practices for fiber use in SBS patients.

Cited by 9 publications

References 22 publications

ASPEN definitions in pediatric intestinal failure

ASPEN definitions in pediatric intestinal failure

Nutritional management of high‐output ileostomies in paediatric patients is vital and more evidence‐based guidelines are needed

Complementary food introduction practices in infants with intestinal failure

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