Children with Intestinal Failure and Parenteral and Enteral Nutrition

Abstract

Intestinal failure (IF) occurs when there is a reduction of functional intestine required for adequate digestion and absorption to meet age-appropriate nutrient, fluid, and growth requirements. In children, the most common form of IF is that due to congenital or acquired disorders, such as surgical resections and necrotizing enterocolitis (NEC). Intestinal epithelial defects and dysmotility disorders are rarer forms of IF. Given the lack of a definite anatomic definition of IF, most consider pediatric IF as dependence on parenteral nutrition (PN) for at least 90 days. The long-term prognosis of IF depends on several factors, including the length and area of intestine impacted, the presence or absence of the ileocecal valve, the ability of the residual bowel to adapt and function, and the status of other organs also involved in digestion and absorption. In many instances, it is a race to have the bowel adapt or have the patient succumb to often fatal complications such as intestinal failure-associated liver disease. The focus of this chapter is to discuss the nutritional management of the pediatric intestinal failure patient, using both parenteral and enteral nutrition feeding modalities and how to transition the patient through the various stages of recovery.