Pediatric Nutrition in Practice

188 Goulet^

Advancement of Feeding

Whatever the route of feeding ( table  4 ), EF ad-
vancement can occur as long as fluid and electro-
lyte balance is maintained and nutritional goals
are achieved ( table 5 ). EF may eventually be tran-
sitioned to oral/bolus feeding, or oral/bolus and
nocturnal feeding, in order to allow more free-
dom from the feeding pump. The transition from
IF to adequate intestinal function can take weeks,
months and sometimes years. The bowel function
of infants with SBS improves over time due to the
opportunity for further intestinal growth. Provi-

sion of EF plays a major role in the management

of any child with IF, even of those for whom com-

plete weaning from PN seems unlikely ( fig. 1 ).

Conclusions

• Intestinal adaptation following resection is a
  physiological process best enhanced by early
  use of the GI tract, especially by OF, which is
  more physiological, furthers oral skills and
  promotes the release of trophic factors such as
  EGF from the salivary glands

SBS

Promote early oral feeding:

• Human milk


• Previously fed formula

Dumping (high stool volume

with reducing substances)

>40% of recommended

daily allowance

‘Drip feeds’

Diluted formulas

No

Good tolerance

of feeding

Ye s

High PN intake for

Semi-elemental achieving growth

ready-to-feed formula

Not tolerated continued

dumping

Elemental formula

challenge

Adjunctive treatment

PN feedingTube (loperamide, cholestyramine, ursodeoxycholic acid)Pharmacologic management Identify risk and setting of SIBO anddiscuss lengthening surgery

Fig. 1. Algorithm for management of feeding.

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