Intestinal support is the need for intravenous nutrition, tube feeding, or both because the intestine cannot absorb enough nutrients when taken by mouth. There are many problems that can result in infants, children and adolescents needing intestinal support. These can include short bowel syndrome, gastroschisis, omphalocele, Hirschsprung’s disease, pseudo-obstruction, among others. Short bowel syndrome has many causes which can include necrotizing enterocolitis, atresia, volvulus, trauma, vascular infarct, meconium ileus, and congenital short bowel syndrome. A less common cause in children is inflammatory bowel disease.
Caring for infants, children, and adolescents with short bowel syndrome and others who need intestinal support is a complex process. Our ultimate goal is to get children to the point that they no longer require either parenteral or enteral nutrition. We strive to help children and their families lead as normal a life as possible even when they still require ongoing specialized nutrition support. This can only be accomplished by a committed team that includes gastroenterologists, surgeons, interventional radiologists, nurse practitioners, nurses, including nutrition support nurses, dietitians, a pharmacist, a social worker, and a secretary. We provide coordinated care both at home and when the child needs to be in the hospital. We work closely together as a team as well as with the child’s primary care physician and other pediatric subspecialists (both medical and surgical).
We provide complete nutritional management through the use of parenteral, enteral, and oral nutrition. We use preventive and treatment strategies for common problems associated with short bowel syndrome and other diseases requiring intestinal support. These problems include diarrhea, small bowel bacterial overgrowth, decreased bone density (osteopenia, osteoporosis), kidney stones, and, for those on parenteral nutrition, line infections, TPN-associated liver disease, and thromboses associated with the need for central lines. For those who develop irreversible intestinal or liver failure, we have a close relationship with several transplant programs.
The majority of children that we care for are able to wean from parenteral nutrition to either all oral or a combination of oral and enteral feedings. The time it takes to reach this goal varies from one person to another.