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Neonatal Short Bowel Syndrome: Nutritional Management and Research Directions

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (30 November 2020) | Viewed by 12294

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Special Issue Editor

Dr. Paola Roggero

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Guest Editor

Department of Clinical Sciences and Community Health, University of Milan, 20122 Milano, Italy
Interests: growth pattern; body composition; premature infant; early nutrition; long-term health; obesity
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Neonatal short bowel syndrome is a clinical condition that necessitates parenteral nutrition in order to sustain growth and development. It is the most common cause of intestinal failure in infants, and its incidence and prevalence are increasing.

Short bowel syndrome in neonatal intensive care unit patients can result from various conditions, particularly intestinal atresia, gastroschisis, necrotizing enterocolitis, and intestinal volvulus. Subsequently, in the acute post-surgical period, functional changes in nutrient absorption and motility take place in the residual gastrointestinal tract.

Even if the residual intestinal length has been correlated with adaptation and survival, the neonatal care improvement, the development of new strategies on parenteral nutrition, the prevention of intravenous infections, and surgical procedures have significantly increased the survival of infants with short bowel syndrome. Therefore, the prognosis of short bowel syndrome has been improving with advances in multidisciplinary intestinal care.

The majority of infants with short bowel syndrome can reach normal growth and development by means of an adequate nutritional strategy and a multidisciplinary approach.

The nutritional research directions on infants with short bowel syndrome have to limit the following clinical problems:

Food avoidance
Long term nutritional deficiency
Micronutrients deficiency
PN-liver failure

Dr. Paola Roggero
Guest Editor

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Keywords

Short bowel syndrome
Parenteral nutrition
Home parenteral nutrition
Neonate
PN-liver failure
Micronutrients deficiency
Long term nutritional deficiency

Published Papers (3 papers)

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Research

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12 pages, 1549 KiB

Open AccessArticle

Plasma and Red Blood Cell PUFAs in Home Parenteral Nutrition Paediatric Patients—Effects of Lipid Emulsions

by Antonella Lezo, Valentina D’Onofrio, Maria Paola Puccinelli, Teresa Capriati, Antonella De Francesco, Simona Bo, Paola Massarenti, Paolo Gandullia, Marta Marin, Liliana Derevlean, Letizia Baldini, Filomena Longo and Antonella Diamanti

Nutrients 2020, 12(12), 3748; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123748 - 05 Dec 2020

Cited by 3 | Viewed by 2678

Abstract

Background: Mixed lipid emulsions (LE) containing fish oil present several advantages compared to the sole soybean oil LE, but little is known about the safety of essential fatty acids (EFA) profile in paediatric patients on long-term Parenteral Nutrition (PN). Aim of the study: to assess glycerophosfolipid polyunsaturated fatty acids (PUFA) levels on plasma and red blood cell (RBC) membrane of children on long term PN with composite LE containing fish oil (SMOF), and to compare it with a group receiving olive oil LE (Clinoleic^®) and to the reference range for age, previously determined on a group of healthy children. Results: A total of 38 patients were enrolled, median age 5.56 (0.9–21.86) years, 15 receiving Clinoleic^®, 23 receiving SMOF. Patients on SMOF showed significantly higher levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), lower levels of arachidonic acid (ARA) and Mead acid (MEAD)/ARA ratio in plasma and RBC compared with patients on Clinoleic^® and with healthy children. Triene:tetraene (T:T) ratio of both groups of patients did not differ from that of healthy children-median plasma (MEAD/ARA: 0.01, interquartile rage (IQR) 0.01, p = 0.61 and 0.02, IQR 0.02, p = 0.6 in SMOF and Clinoleic^® patients, respectively), and was considerably lower than Holman index (>0.21). SMOF patients showed no statistically significant differences in growth parameters compared with Clinoleic^® patients. Patients of both groups showed stiffness class F0-F1 of liver stiffness measure (LSM) 5.6 (IQR 0.85) in SMOF patients and 5.3 (IQR 0.90) in Clinoleic^® patients, p = 0.58), indicating absence of liver fibrosis. Conclusions: Fatty acids, measured as concentrations (mg/L), revealed specific PUFA profile of PN patients and could be an accurate method to evaluate nutritional status and eventually to detect essential fatty acid deficiency (EFAD). SMOF patients showed significantly higher EPA, DHA and lower ARA concentrations compared to Clinoleic^® patients. Both LEs showed similar hepatic evolution and growth. Full article

(This article belongs to the Special Issue Neonatal Short Bowel Syndrome: Nutritional Management and Research Directions)

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Review

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22 pages, 1439 KiB

Open AccessReview

Optimizing Nutritional Strategies to Prevent Necrotizing Enterocolitis and Growth Failure after Bowel Resection

by Laura Moschino, Miriam Duci, Francesco Fascetti Leon, Luca Bonadies, Elena Priante, Eugenio Baraldi and Giovanna Verlato

Nutrients 2021, 13(2), 340; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020340 - 24 Jan 2021

Cited by 20 | Viewed by 5226

Abstract

Necrotizing enterocolitis (NEC), the first cause of short bowel syndrome (SBS) in the neonate, is a serious neonatal gastrointestinal disease with an incidence of up to 11% in preterm newborns less than 1500 g of birth weight. The rate of severe NEC requiring surgery remains high, and it is estimated between 20–50%. Newborns who develop SBS need prolonged parenteral nutrition (PN), experience nutrient deficiency, failure to thrive and are at risk of neurodevelopmental impairment. Prevention of NEC is therefore mandatory to avoid SBS and its associated morbidities. In this regard, nutritional practices seem to play a key role in early life. Individualized medical and surgical therapies, as well as intestinal rehabilitation programs, are fundamental in the achievement of enteral autonomy in infants with acquired SBS. In this descriptive review, we describe the most recent evidence on nutritional practices to prevent NEC, the available tools to early detect it, the surgical management to limit bowel resection and the best nutrition to sustain growth and intestinal function. Full article

(This article belongs to the Special Issue Neonatal Short Bowel Syndrome: Nutritional Management and Research Directions)

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15 pages, 516 KiB

Open AccessReview

To Wean or Not to Wean: The Role of Autologous Reconstructive Surgery in the Natural History of Pediatric Short Bowel Syndrome on Behalf of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP)

by Teresa Capriati, Antonella Mosca, Tommaso Alterio, Maria Immacolata Spagnuolo, Paolo Gandullia, Antonella Lezo, Paolo Lionetti, Lorenzo D’Antiga, Fabio Fusaro and Antonella Diamanti

Nutrients 2020, 12(7), 2136; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12072136 - 18 Jul 2020

Cited by 10 | Viewed by 3485

Abstract

Pediatric Short Bowel Syndrome (SBS) can require prolonged parenteral nutrition (PN). Over the years, SBS management has been implemented by autologous gastrointestinal reconstructive surgery (AGIR). The primary objective of the present review was to assess the effect of AGIR on weaning off PN. We also evaluated how AGIR impacts survival, the need for transplantation (Tx) and the development of liver disease (LD). We conducted a systematic literature search to identify studies published from January 1999 to the present and 947 patients were identified. PN alone was weakly associated with higher probability of weaning from PN (OR = 1.1, p = 0.03) and of surviving (OR = 1.05, p = 0.01). Adjusting for age, the probability of weaning off PN but of not surviving remained significantly associated with PN alone (OR = 1.08, p = 0.03). Finally, adjusting for age and primary diagnosis (gastroschisis), any association was lost. The prevalence of TX and LD did not differ by groups. In conclusion, in view of the low benefit in terms of intestinal adaptation and of the not negligible rate of complications (20%), a careful selection of candidates for AGIR should be required. Bowel dilation associated with failure of advancing EN and poor growth, should be criteria to refer for AGIR. Full article

(This article belongs to the Special Issue Neonatal Short Bowel Syndrome: Nutritional Management and Research Directions)

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