Innovative parenteral and enteral nutrition therapy for intestinal failure

Abstract

Children with intestinal failure (IF) suffer from insufficient intestinal length or function, making them dependent on parenteral nutrition (PN) for growth and survival. PN and its components are associated with many complications ranging from simple electrolyte abnormalities to life-threatening PN-associated liver disease, which is also called intestinal failure-associated liver disease (IFALD). From a nutrition perspective, the ultimate goal is to provide adequate caloric requirements and make the transition from PN to full enteral nutrition (EN) successful. Upon review of the literature, we have summarized the most effective and innovative PN and EN therapies for this patient population. Antibiotic-coated catheters and antibiotic or ethanol locks can be implemented, as they appear effective in reducing catheter-related infection and thus further reduce the risk of IFALD. Lipid emulsions should be given judiciously. The use of an omega-3 fatty acid-based formulation should be considered in patients who develop IFALD. Trophic feeding is important for intestinal adaptation, and EN should be initiated early to help wean patients from PN. Long-term management of children with IF continues to be an emerging field. We have entered uncharted territory as more children survive complications of IF and IFALD. Careful monitoring and individualized management to ensure maintenance of growth while avoiding complications are the keys to successful patient outcomes.

Figure 1

Weekly median trends direct bilirubin levels from baseline until cessation of PN. Mean time to reversal of cholestasis while receiving PN in the fish oil group (N=56) was 81 days compared to 492 days (P<0.0001) in the historical control soybean group (N=31). The rate of reversal while on PN of the fish oil group was 89% compared to 16% of the soybean controls (P<0.0001). [Black] and (Blue) represent number of subjects in the fish oil group and the soybean control group, respectively, at specific time points.