Management of pediatric intestinal failure

Abstract

Intestinal failure (IF) is defined as the state of the intestinal tract where the function is below the minimum required for the absorption of macronutrients, water, and electrolytes. The etiology may be a multitude of causes, but short bowel syndrome (SBS) remains the most common. The successful management and prognosis of SBS in infants and children depends a multitude of variables such as length, quality, location, and anatomy of the remaining intestine. Prognosis, likewise, depends on these factors, but also is dependent on the clinical management of these patients. Strategies for a successful outcome and the success of therapeutic interventions are dependent upon understanding each individual's remaining intestinal function. Medical intervention success is defined by a graduated advancement of enteral nutrition (EN) and a reduction of parenteral nutrition (PN). Complications of IF and PN include progressive liver disease, bacterial overgrowth, dysmotility, renal disease, catheter related bloodstream infections, and loss of venous access. Surgical interventions such as bowel lengthening procedures show promise in carefully selected patients. Intestinal transplantation is reserved for those infants and children suffering from life-threatening complications of PN.