Short bowel syndrome in infants: the critical role of luminal nutrients in a management program.
Short bowel syndrome develops when the remnant mass of functioning enterocytes following massive resections cannot support growth or maintain fluid-electrolyte balance and requires parenteral nutrition. Resection itself stimulates the intestine's inherent ability to adapt morphologically and functionally. The capacity to change is very much related to the high turnover rate of enterocytes and is mediated by several signals; these signals are mediated in large part by enteral nutrition. Early initiation of enteral feeding, close clinical monitoring, and ongoing assessment of intestinal adaptation are key to the prevention of irreversible intestinal failure. The length of the functional small bowel remnant is the most important variable affecting outcome. The major objective of intestinal rehabilitation programs is to achieve early oral nutritional autonomy while maintaining normal growth and nutrition status and minimizing total parenteral nutrition related comorbidities such as chronic progressive liver disease. Remarkable progress has been made in terms of survivability and quality of life, especially in the context of coordinated multidisciplinary programs, but much work remains to be done.
a Département de Pédiatrie, Service de gastroentérologie, hépatologie et nutrition, CHU Sainte-Justine et Université de Montréal, 3175 chemin de la Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada.
Claude C
CC
Roy
Véronique
V
Groleau
Lise
L
Bouthillier
Marjolain
M
Pineault
Maxime
M
Thibault
Valérie
V
Marchand
D002675:Child, Preschool; D005502:Food; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018529:Nutritional Support; D012778:Short Bowel Syndrome / Q000628:therapy*
adaptation intestinale; enteral nutrition; infants; insuffisance intestinale; intestinal adaptation; intestinal failure; nourrisson; nutrition entérale; nutrition parentérale; parenteral nutrition; short bowel syndrome; syndrome de l’intestin court