Management of premature infants with extensive bowel resection with high volume enteral infusates.
To avoid long-term parenteral nutrition (PN), three premature infants with extensive bowel resections were fed high volume enteral infusates (HVEI). Following surgery an elemental hypo-osmolar gastric infusate was initiated. The infants were weaned of PN and were subsequently maintained on HVEI feeding. Rather than using the volume of the ileostomy outputs or the presence of reducing substances as guides for adjustment of enteral intake, we tolerated large ileostomy output and focused instead on the patients' hydration, serum electrolytes and acid base status. During HVEI feeding, the patients had sustained weight gain, while the mean +/- SD enteral intakes were 373 +/- 67, 689 +/- 132, and 415 +/- 108 ml/kg per day; osmolarity of enteral infusates were 250 +/- 25, 225 +/- 40 and 228 +/- 27 mosmol/l; caloric intakes were 163 +/- 29, 258 +/- 54, and 153 +/- 44 Kcal/kg per day; and ileostomy outputs were 113 +/- 47, 228 +/- 59, and 175 +/- 69 ml/kg per day, respectively. Gut adaptation lasted 122, 141, and 205 days, respectively. Re-anastomoses of the intestines were performed at the ages of 8, 78, and 36 months. At 18, 108, and 58 months, infants' weights were in the 50th, 20th, and 5th percentiles, respectively. No infant developed cirrhosis. High volume enteral infusate feeding in infants with extensive bowel resection may help achieve gut adaptation and may serve as an alternative nutrition modality to prolonged PN.
Alkalay
A L
AL
Division of Neonatology, Ahmanson Pediatric Center, Cedars-Sinai Medical Center, University of California, Los Angeles School of Medicine 90048, USA.
Fleisher
D R
DR
Pomerance
J J
JJ
Rosenthal
P
P
D000136:Acid-Base Equilibrium; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D004761:Enterocolitis, Pseudomembranous / Q000601:surgery; D005260:Female; D006801:Humans; D007081:Ileostomy; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009994:Osmolar Concentration; D011182:Postoperative Care; D014882:Water-Electrolyte Balance; D015430:Weight Gain