title: Triple tube therapy: a novel enteral feeding technique for short bowel syndrome in low-income countries.
abstract: OBJECTIVE
  Short bowel syndrome (SBS) is a global malabsorption syndrome that results from extensive intestinal resection. We report our experience of 10 neonates with short bowel managed by a novel triple tube enteral feeding technique. The aim of this research was to provide justification for enteral nutritional strategies to enhance intestinal adaptation, especially in developing countries where parenteral nutrition is either unavailable or expensive.
  
  
  METHODS
  From March 2004 to January 2006, 10 neonates underwent extensive bowel resection, enterostomy, and mucous fistula for necrotizing enterocolitis or midgut volvulus and were managed postoperatively with triple tube enteral feeding technique. Gestational age, birth weight, primary abdominal pathology, timing of surgery, surgical procedure performed, complications, duration and feasibility of refeeding, and weight gain were recorded.
  
  
  RESULTS
  The group was composed of 8 male and 2 female neonates with a mean gestational age of 34.2 +/- 4.6 weeks and mean birth weight of 2580 +/- 993 g. Necrotizing enterocolitis accounted for 7 (70%) and midgut volvulus accounted for 3 (30%) cases of SBS. Mean gestational age at surgery was 35.5 +/- 2.2 weeks. Mean residual small bowel length and colon length after resection were 35.5 +/- 3.5 and 30.5 +/- 1.5 cm, respectively. Weight gain during refeeding ranged from 3 to 6 g/kg per day with duration of refeeding lasting 20 to 156 days. Reanastomoses was done 92 +/- 4.2 days after the primary surgery. There were 3 surgery-related complications, but no mortality. Mean period of follow-up was 12 +/- 2.4 months. Five of the 10 children are now 19 months old and have a body weight of -1.5 +/- 0.64 SD scores and height of -1.75 +/- 0.99 SD scores.
  
  
  CONCLUSIONS
  This technique represents a safe and effective enteral nutrition strategy that eliminates the need for total parenteral nutrition for SBS in developing countries.
authors.affiliation: Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. akshay_pratap2000@yahoo.co.in
authors.forename: Akshay
authors.initials: A
authors.lastname: Pratap
authors.forename: Navneet
authors.initials: N
authors.lastname: Kaur
authors.forename: Vikal Chandra
authors.initials: VC
authors.lastname: Shakya
authors.forename: Ganga
authors.initials: G
authors.lastname: Sapkota
authors.forename: Syed
authors.initials: S
authors.lastname: Tanveer-ur Rahman
authors.forename: Binay Kumar
authors.initials: BK
authors.lastname: Biswas
authors.forename: Chandra Shekhar
authors.initials: CS
authors.lastname: Agrawal
authors.forename: Shailesh
authors.initials: S
authors.lastname: Adhikary
mesh_terms: D003906:Developing Countries; D004750:Enteral Nutrition / Q000295:instrumentation*; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000150:complications / Q000601:surgery; D008297:Male; D009390:Nepal; D011203:Poverty; D012778:Short Bowel Syndrome / Q000209:etiology / Q000628:therapy*