Enteral Support for Children with Intestinal Failure
Enteral (i.e. passing through the intestine either via the mouth or tube feeding) is critical to maintain normal intestinal structure and function. In order to transition your child from parenteral to enteral nutrition (EN), the intestinal epithelium (lining) must adapt to optimize nutrition absorption. (1)
Your team of surgeons, gastroenterologists, and dieticians will work with you and your child to determine the optimal formula and diet to help the intestine adapt. In general, carbohydrates may be poorly tolerated by intestinal failure patients as they are broken down by the gastrointestinal tract bacteria into small, osmotically (water) active organic acids that can cause a large amount of water to be drawn into the distal small intestine and colon, causing large fluid losses. Moderate amounts of fat are usually tolerated in the short bowel syndrome diet as well as protein.
Your child may also become dehydrated quickly due to large fluid losses from a high output ostomy, persistent secretory diarrhea, or pseudo-obstruction resulting in large gastric and duodenal losses. In cases like these, an oral rehydration solution containing glucose and sodium may be recommended. You may be required to monitor your child’s urine and stool output to assess the hydration status of your child.
If your child has short bowel syndrome or persistent diarrhea and is requiring tube feedings, a continuous feed through a nasogastric (NG) tube or gastrostomy tube may be recommended. This permits constant saturation of the carrier proteins, thus taking full advantage of the limited absorptive area of the intestine. (2)
It is important to understand that the transition from intestinal failure to adequate intestinal function and the ability to wean from total parenteral nutrition to full enteral feeding can take weeks, months, and even years.
Bharadwaj S, Tandon P, Gohel TD, et al. Current status of intestinal and multivisceral transplantation. Gastroenterology Report. 2017;5(1):20-28. doi:10.1093/gastro/gow045.
Langnas AN, Goulet O, Quigley EMM, Tappenden KA. Intestinal Failure Diagnosis, Management, and Transplantation. Malden, MA: Blackwell; 2008.