K Tse, CO Sham, KW Chan, C Yeung

Abstract

Aggressive and continuous feeding regimes for children with short bowel syndrome (SBS) have been recommended in literatures for decades. Adequate bowel rest has not been addressed for bowel adaptation in literature previously. Our patient is a term infant girl with ultra short bowel after massive small bowel resection for volvulus on the third day of life. When on aggressive feeding regimen, she developed rectal bleeding and shock. After bowel rest, milk feeding was resumed at a volume corresponding to her remnant bowel length. She was on small bolus feeds via syringe every 2 hours. The advancement interval was according to the intestinal mucosal turnover time. The total nutrient given by oral and intra-venous routes were as for usual infant, about 100 kcal/kg/day. She achieved full enteral autonomy by 9.5-month-old with a body weight of 8.54 kg. She was discharged by 10.5-month-old. In our physiological feeding regime, tube feeding, prokinetics, anti-diarrheal agents, cyclic antibiotics, probiotics, hormonal therapy, or repeated bowel operations were not needed. Different from the usual recommendations for infants with SBS, excessive milk feeding was not needed all along and even beyond enteral autonomy.