Neonatal short bowel syndrome as a model of intestinal failure: physiological background for enteral feeding

Area of Science:

• Pediatric gastroenterology and nutrition
• Intestinal failure and short bowel syndrome management

Background:

• Intestinal failure (IF) significantly impairs nutrient digestion and absorption in children, hindering growth.
• Short bowel syndrome (SBS), often resulting from neonatal intestinal resection, is the primary cause of IF in pediatric populations.
• Managing nutritional status and promoting intestinal adaptation concurrently presents a major clinical challenge for SBS patients.

Purpose of the Study:

• To review the physiological principles and current nutritional management strategies for pediatric intestinal failure.
• To discuss controversies and provide evidence-based recommendations for enteral nutrition (EN) in children with SBS.
• To explore methods for optimizing intestinal adaptation and mitigating small intestinal bacterial overgrowth.

Main Methods:

• A consensus-based review of existing literature and clinical practices.
• Discussion of physiological principles guiding nutritional support.
• Analysis of enteral nutrition delivery routes and dietary considerations.

Main Results:

• Nutritional management of pediatric intestinal failure, particularly SBS, remains largely experience-based rather than evidence-based.
• Optimal enteral nutrition strategies, including diet type and delivery method, require further clarification.
• Synergistic consideration of growth, development, and gut adaptation is crucial for outcome assessment.

Conclusions:

• A consensus-driven approach is needed to standardize the nutritional management of children with intestinal failure and SBS.
• Further research and evidence-based guidelines are essential to improve patient outcomes.
• Focusing on both nutritional support and intestinal adaptation is key to successful management.