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Clinical Nutrition

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Pediatric Digestive Surgery

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Abstract

Pediatric patients are particularly vulnerable to the disease-related consequences of malnutrition; they may be prevented by applying in clinical practice the techniques of artificial nutrition (AN) that include enteral nutrition (EN) and parenteral nutrition (PN). The most appropriate nutritional intervention will be determined by assessing several factors; the decisional tree starts, nevertheless, from the gut function. When gut function is impaired, as in all forms of intestinal failure (IF), PN should be approached. IF refers to all states where the intestine has inadequate absorptive capacity to meet nutritional, fluid, and electrolyte needs to sustain life and growth requirements of a child. Although PN should be firstly considered in IF, EN should be also employed. Even minimal quantities of nutrients in the gastrointestinal tract (so-called trophic feeding) may promote intestinal perfusion, initiate release of enteral hormones, and improve gut barrier function. IF may be due to short bowel syndrome (SBS) or abnormal gut function. SBS is particularly reliable to provide a model of combined PN/EN management. The key concept of nutritional care in SBS is to give the maximum tolerated EN combined with the ongoing support of PN. The first phase of nutritional workup will be early managing of fluid and electrolyte losses before starting PN and EN, followed by optimizing PN and EN intake. If transition from PN to full EN is expected over a long period, home PN should be required. SBS outcome is improved by a multidisciplinary approach that allows for fully integrated care of inpatients and outpatients by favoring coordination of surgical, medical, and nutritional management.

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Authors and Affiliations

  1. Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù “Children Hospital”, Piazza S. Onofrio 4, 00165, Rome, Italy

    Teresa Capriati & Daniela Giorgio

  2. Artificial Nutrition Unit, Bambino Gesù Children’s Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy

    Antonella Diamanti MD

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  1. Antonella Diamanti MD
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  2. Teresa Capriati
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Correspondence to Antonella Diamanti MD .

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Editors and Affiliations

  1. Pediatric Surgery, S. Orsola-Malpighi Hospital Bologna University, Bologna, Italy

    Mario Lima

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Diamanti, A., Capriati, T., Giorgio, D. (2017). Clinical Nutrition. In: Lima, M. (eds) Pediatric Digestive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-40525-4_6

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  • DOI: https://doi.org/10.1007/978-3-319-40525-4_6

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