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Published on: July 30, 2011
Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient
Elissa M Downs1, Amanda Brun2, Melena D Bellin3
1Pediatric Gastroenterology, Hepatology, and Nutrition, M Health Fairview, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
Insights
Postoperative nutrition for children undergoing total pancreatectomy with islet autotransplantation requires careful management due to potential complications. Lifelong enzyme replacement, vitamin supplementation, and dietary adjustments are crucial for managing exocrine insufficiency and ensuring optimal health outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutrition Science
Background:
- Children with chronic pancreatitis often experience diminished quality of life and chronic pain.
- Total pancreatectomy with islet autotransplantation is a complex procedure for managing severe pancreatic conditions in children.
- Postoperative nutrition support presents unique challenges in this pediatric population.
Purpose of the Study:
- To outline the specific characteristics and considerations for postoperative nutrition support in children undergoing total pancreatectomy with islet autotransplantation.
- To highlight potential complications and necessary modifications to nutrition regimens.
- To emphasize the importance of long-term nutritional monitoring and management.
Main Methods:
- Review of nutritional management strategies for pediatric patients post-total pancreatectomy with islet autotransplantation.
- Identification of common postoperative complications affecting nutrition (e.g., dysmotility, exocrine insufficiency).
- Description of dietary recommendations, including enzyme replacement, vitamin supplementation, low-oxalate diet, and carbohydrate counting.
Main Results:
- Surgical complications can delay nutrition support initiation or necessitate regimen modifications.
- Early postoperative dysmotility often requires temporary enteral nutrition.
- Complete exocrine pancreatic insufficiency mandates lifelong pancreatic enzyme replacement therapy and fat-soluble vitamin supplementation.
- A low-oxalate diet is advised to prevent kidney stones.
- Carbohydrate counting is essential for insulin dosing, varying in duration based on islet yield.
Conclusions:
- Postoperative nutrition support for children undergoing total pancreatectomy with islet autotransplantation is multifaceted.
- Lifelong management including enzyme therapy, vitamin supplementation, and specific dietary guidelines is essential.
- Regular, long-term nutrition assessment and monitoring are critical for optimizing outcomes in these children.
Abstract:
For children with diminished quality of life and chronic pain caused by acute recurrent or chronic pancreatitis who are undergoing total pancreatectomy with islet autotransplantation, postoperative nutrition support has several unique characteristics. Surgical complications may lead to delays in nutrition support initiation or require modifications to the regimen. Early postoperative dysmotility requires the use of temporary enteral nutrition until this improves. The resultant complete exocrine pancreatic insufficiency necessitates lifelong pancreatic enzyme replacement therapy and fat-soluble vitamin supplementation. A low-oxalate diet is recommended to prevent kidney stones. Carbohydrate counting is needed for the provision of short-term insulin dosing and possibly long-term as well, depending on the transplanted islet yield. Children should have careful nutrition assessment and monitoring at several follow-up visits during the first year, then annually, and at any time with concerns.
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