Neonatal feeding in practice: Nutrition principles for babies with a history of intestinal injury or resection.

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Date: Oct. 2021
From: Contemporary Pediatrics(Vol. 38, Issue 10)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 2,419 words
Lexile Measure: 1850L

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Infants who have a history of intestinal injury as neonates can pose challenges for the pediatricians who care for these babies after they are discharged from the hospital. Here are some of the causes, feeding guidelines, and approaches to feeding difficulties that you can use in your practice.

Common causes of neonatal intestinal injury include necrotizing enterocolitis (NEC), spontaneous intestinal perforation, gastroschisis, intestinal atresia, and volvulus (Table 1). Intestinal injury in the neonate typically presents acutely with vomiting, inability to tolerate enteral feeds, abdominal distention, and bloody stools. Treatment typically requires at least the temporary adoption of bowel rest and parenteral nutrition. (1)

Intestinal failure is generally defined by the loss of normal function of the intestine, regardless of length of residual small bowel, resulting in reliance on parenteral nutrition for calories and fluid to sustain life. (2) NEC and gastroschisis are the most common causes of long-term intestinal failure in infants, which results in significant morbidity, mortality, and cost to families and medical systems. (1,2) Those infants who undergo significant intestinal resection and intestinal failure, and thus need long-term parenteral nutrition, require specialized care in multidisciplinary intestinal rehabilitation centers. However, the majority of infants with intestinal injury will tolerate enteral nutrition by hospital discharge. (3) Therefore, the majority of these infants will be cared for by their primary pediatricians, who should be aware that these infants are prone to a variety of ongoing nutritional challenges.

Feeding difficulties include poor oral intake, failure to thrive, nutrient deficiencies, gastroesophageal reflux disease (GERD), and intestinal dysmotility. Intestinal dysmotility secondary to resection or injury can cause chronic vomiting, diarrhea, abdominal distention, and small intestinal bacterial overgrowth (SIBO). More than 50% of infants with intestinal injury are prescribed medications to address 1 or more of these issues. (2) Overall positive prognostic indicators for successful tolerance of enteral feeds in these infants include the residual length of the small bowel following resection (the longer the residual bowel, the better), the presence of an intact ileocecal valve, and an intact colon; therefore, it is important to understand the infant's surgical course, residual anatomy, and any neuro developmental sequelae. (4)

General feeding guidelines and principles

The importance of feeding guidelines and algorithms for preterm and other critically ill infants who are at increased risk of NEC are well established. (5) However, guidelines for feeding following intestinal injury are not standardized; they can be highly variable across institutions and even among providers at the same institutions. (2,6)

Enteral feeding stimulates the intestine to heal and grow. Data have shown that early implementation of enteral feeds following intestinal injury (<5-7 days) promotes intestinal adaptation and is not associated with worse outcomes or recurrence of NEC. (7) In fact, early feeding with the use of consistent, standardized feeding advancement has been associated with shorter length of stay, quicker achievement of enteral feeding goals, fewer infectious complications, and reduced overall cost to the patient and health system. (8,9) For those patients who require surgery for intestinal injury, guidelines support early postoperative...

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Gale Document Number: GALE|A679076287