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Recent Advances in Nutritional Care of Patients with Intestinal Failure

  • Antonella DiamantiEmail author
  • Teresa Capriati
  • Domenica Elia
Chapter

Abstract

Intestinal failure (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. IF leads to chronic dependence on parenteral nutrition (PN) to maintain adequate growth, hydration, and micronutrient balance. The etiology of IF recognizes the short bowel syndrome (SBS) where congenital or acquired lesions have determined extensive loss of intestinal mass, as the most frequent underlying IF disease. Malabsorption due to ineffective mucosal surface or motility disorders is a further cause of IF. Nutritional workup of pediatric IF is usually complex; the key concept of the overall nutritional care is to integrate the maximum tolerated amount of enteral intake with the ongoing support of PN. The final objective is to achieve total or partial intestinal rehabilitation according to the etiology of IF. The nutritional care of pediatric IF includes the following steps: (1) early managing of fluid and electrolyte losses before starting PN and enteral nutrition (EN); (2) providing adequate PN, for growth and normal development; (3) promoting intestinal rehabilitation by optimizing EN; (4) discharging on home parenteral nutrition (HPN) the patients with predicted long-term PN; and (5) preventing/treating complications related to the patient’s underlying disease and their PN. IF outcome is significantly improved if it is managed by a multidisciplinary team that allows for fully integrated care of inpatients and outpatients by favoring coordination of surgical, medical, and nutrition management.

Keywords

Intestinal failure Parenteral nutrition Enteral nutrition Children 

Abbreviations

ASPEN

American Society for Parenteral and Enteral Nutrition

AFs

Amino acid-based formulas

BF

Breastfeeding

CIPOs

Chronic intestinal pseudo-obstructions

CVC

Central venous catheter

EN

Enteral nutrition

FO

Fish oil-based LEs

HD

Hirschsprung’s diseases

HFs

Hydrolyzed formulas

HPN

Home parenteral nutrition

IF

Intestinal failure

IFALD

Intestinal failure-associated liver disease

ITx

Intestinal transplant

LCTs

Long-chain triglycerides

LEs

Lipid emulsions

MCTs

Medium-chain triglycerides

PN

Parenteral nutrition

PUFA

Polyunsaturated fatty acids

SBS

Short bowel syndrome

SCFAs

Short-chain fatty acids

SMOF lipids

Mixture of 30 % of SO, 30 % of coconut oil, 25 % of olive oil, and 15 % of FO

SO

Soybean oil-based lipids

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Antonella Diamanti
    • 1
    Email author
  • Teresa Capriati
    • 2
  • Domenica Elia
    • 2
  1. 1.Hepatology, Gastroenterology and Nutrition UnitBambino Gesù “Children Hospital”RomeItaly
  2. 2.Artificial Nutrition UnitBambino Gesù Children’s HospitalRomeItaly

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