Welcome to the Center for Intestinal Rehabilitation and Nutrition Support at Nationwide Children’s Hospital.
Our team provides the nutritional, gastrointestinal and surgical care of infants, children and adolescents who have intestinal failure related to short bowel syndrome or other causes. Our team includes:
Nutrition support involves the provision of specialized nutrition given parenterally (intravenously through a catheter in a vein) and/or enterally (through the gastrointestinal tract). We do this because the intestine cannot absorb enough nutrients for growth when taken solely by mouth.
The ultimate goal of care is to help children get to the point that they no longer need either parenteral or enteral nutrition. In some children, we achieved this over months, in others it can take years. This is not possible for every child with intestinal failure, depending on the specific cause, but it is always our goal. Achieving this goal is the result of intestinal adaptation, which includes growth of the lining of the intestine and enhancement of its function. One key to this is advancing enteral nutrition, which stimulates the process of intestinal adaptation.
Children may require nutritional support for a variety of reasons including:
We offer expertise in parenteral and enteral support assessment, management, and follow-up as well as management of the complications associated with intestinal failure and short bowel syndrome. This care is provided by the same team in both the outpatient clinic setting and, when admission is needed, in the hospital.
Intestinal failure is a condition in which the intestines are not able to absorb enough nutrients, fluids and/or electrolytes to maintain hydration and achieve appropriate weight gain and growth. This can be due to short bowel syndrome or other conditions which impair the motility or function of the GI tract. Some of these other conditions include Hirschsprung’s disease, intestinal pseudo-obstruction, or impaired mucosal function.
Short bowel syndrome is exactly what the name sounds like - a condition in which the bowel is too short generally due to surgical resection. Most commonly, the need for surgical resection has occurred in infancy because babies are born with abnormal intestines or develop serious damage to the intestine. Older children may have short bowel syndrome due to trauma or inflammatory bowel disease, although this is rare in children. Conditions in infancy include gastroschisis or omphalocele, intestinal atresias, necrotizing enterocolitis, meconium ileus, volvulus or Hirschsprung’s disease.
The normal function of the intestine is to absorb fluid and nutrients. When the intestine cannot do this effectively, malabsorption occurs and results in complications. Most importantly, the child cannot gain weight or grow, but other problems also occur. When children are first diagnosed with short bowel syndrome, they often require special nutrition via a catheter in their veins (IV nutrition) which is called total parenteral nutrition or TPN. With this therapy, sugar, protein, fat and electrolytes are provided intravenously. The amount of this kind of nutrition is generally decreased over time as enteral nutrition (nutrition through the GI tract) is advanced and the intestine begins to tolerate more of the needed nutrition. This can be a slow process. When this kind of nutrition support is needed for months, children are considered to have intestinal failure.
Some of the common complications associated with short bowel syndrome include diarrhea, small bowel bacterial overgrowth, decreased bone density (osteopenia or osteoporosis), kidney stones, and, for those who require parenteral nutrition, blood stream infections, intestinal failure-associated liver disease, and thromboses (fixed blood clots) associated with the need for central lines.
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 child to another.