Nutritional Management of Infants with Short Bowel Syndrome

Short Bowel Syndrome (SBS) is a clinically significant condition affecting the NICU population. The morbidity and mortality of SBS is most often the result of prolonged dependency on parenteral nutrition. Nutritional management of these patients is complex and studies indicate that clinical outcomes are better among infants with SBS when enteral feedings are initiated sooner rather than later. Primary Children's Medical Center (PCMC) in Salt Lake City, UT serves neonatal patients with SBS. Currently there is no guideline in place to manage the complex nutritional needs of these patients. The purpose of this scholarly project was to develop a guideline to manage both parenteral and enteral nutrition in patients with SBS. The objectives for this project included: (1) developing a clinical practice guideline, (2) using the most current evidence and eliciting input from content experts during development of the guideline, (3) incorporation of the guideline into clinical practice, and (4) dissemination of the guideline to a wider audience of professional peers and colleagues. A clinical practice guideline was developed to serve as a roadmap for neonatal practitioners who manage the complex needs of infants with SBS. Recommendations contained in the guideline were derived from the research literature in addition to input from content experts. The guideline provides management strategies for the three phases of nutritional management. The first phase occurs just after bowel resection when fluid and electrolyte disturbances occur. Recommendations for macronutrients and micronutrients to be included or excluded in the parenteral nutrition are contained in the guideline. Total fluid and caloric goals are also provided. During the second phase, infants with SBS are introduced to enteral feedings. Recommendations are made on when to initiate feeds, the type of feeding to provide, and when to advance or hold enteral feedings. The final phase occurs as the patient is weaned from parenteral nutrition. Recommendations for enteral caloric goals, laboratory monitoring, and expected complications are included. In addition to previously noted recommendations for nutritional management, the guideline also provides information on important laboratory studies to monitor, classes of medications to treat SBS, and symptoms of feeding intolerance. The guideline has received approval from the content experts. Presentation of the guideline to the Division of Neonatology at PCMC is tentatively scheduled for June 2013. A research study in collaboration with the content experts to evaluate the effectiveness of the guideline has been proposed. Outcomes measures of interest that will be examined include length of hospitalization, time to enteral feeds, growth, length of dependency on parenteral nutrition, and complications. Upon completion of the study, a manuscript will be written for submission to a peer reviewed journal.