Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Short bowel syndrome · Intestinal adaptation ·

Protracted diarrhea of infancy · Parenteral

nutrition · Feeding, oral, enteral · Breast milk ·

Long-chain fatty acid-containing formulas ·

Medium-chain triglycerides · Hydrolyzed protein

formulas · Amino acid formulas · Small intestinal

bacterial overgrowth · Feeding aversion

Key Messages

• Protracted diarrhea of infancy or short bowel syn-
  drome (SBS) requires parenteral nutrition together
  with oral feeding (OF) or enteral feeding (EF). The
  use of the gastrointestinal (GI) tract as early and as
  much as possible, according to clinical tolerance,
  should be promoted and feeding aversion pre-
  vented


• Adaptation – the physical and physiological pro-
  cesses by which the intestine compensates for loss
  of intestinal length or function – is optimized with
  the provision of OF or EF


• Direct mucosal contact with nutrients, pancreatico-
  biliary secretions and neurohormonal factors ex-
  plains how the use of the GI tract promotes physio-
  logical intestinal adaptation. It may also contribute
  to preventing cholestasis and liver disease


• The intestinal microbiota has both positive (short-
  chain fatty acid production) and deleterious effects
  (intraluminal bacterial overgrowth)
  
  
  • The types of diet regarding breast milk, protein hy-
    drolysates and formulas containing amino acids or
    long- or medium-chain fatty acids remain contro-
    versial. The routes (oral, gastric and transpyloric)
    and the modes (bolus, continuous or both) of feed-
    ing are also debated. Very few randomized trials
    have been performed © 2015 S. Karger AG, Basel
  
  
  
  

Introduction

The so-called protracted diarrhea of infancy

(PDI), which has become a rare condition in de-

veloped countries, is caused by severe malabsorp-

tion secondary to an acquired intestinal mucosal

injury due to infection, inflammation or allergic

reaction. ‘Intractable diarrhea of infancy’ refers to

congenital enteropathies involving the develop-

ment or renewal of intestinal mucosa that lead to

very long-lasting or often irreversible intestinal

failure (IF) [1]. Short bowel syndrome (SBS) is the

leading cause of IF and is a state of malabsorption

following extensive small intestinal resection.

The functional consequences as well as the prog-

nosis of SBS depend on the age-adjusted small

bowel length, site of resection, presence or ab-

sence of the ileocecal valve (ICV) and occurrence

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 182–189
DOI: 10.1159/000360339

3.9 Malabsorptive Disorders and Short Bowel

Syndrome

Olivier Goulet