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Management of premature infants with extensive bowel resection with high volume enteral infusates
A L Alkalay1, D R Fleisher, J J Pomerance
1Division of Neonatology, Ahmanson Pediatric Center, Cedars-Sinai Medical Center, University of California, Los Angeles School of Medicine 90048, USA.
Insights
High volume enteral infusates (HVEI) offer an alternative to prolonged parenteral nutrition (PN) for premature infants with extensive bowel resections. This feeding strategy promotes gut adaptation and sustained weight gain, avoiding complications like cirrhosis.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Nutritional Support
Background:
- Premature infants with extensive bowel resections often require long-term parenteral nutrition (PN).
- Achieving adequate gut adaptation and nutritional support is critical for these vulnerable infants.
Purpose of the Study:
- To evaluate the efficacy of high volume enteral infusates (HVEI) as an alternative to prolonged PN in premature infants with extensive bowel resections.
Main Methods:
- Three infants with extensive bowel resections were initiated on elemental, hypo-osmolar gastric infusates post-surgery.
- Parenteral nutrition was weaned, and infants were maintained on HVEI, with adjustments based on hydration and electrolyte status rather than ileostomy output.
- Key parameters monitored included enteral intake, infusate osmolarity, caloric intake, ileostomy output, weight gain, and acid-base status.
Main Results:
- Infants demonstrated sustained weight gain during HVEI feeding.
- Mean enteral intakes ranged from 373-689 ml/kg/day, with caloric intakes from 153-258 Kcal/kg/day.
- Gut adaptation periods varied (122-205 days), with successful intestinal re-anastomoses performed later. No infants developed cirrhosis.
Conclusions:
- High volume enteral infusate feeding can facilitate gut adaptation in infants with extensive bowel resections.
- HVEI represents a viable alternative nutritional strategy, potentially reducing the need for prolonged parenteral nutrition in this patient population.
Abstract:
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.