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.

數十年來，文獻中一直推薦對於超短腸綜合症的患兒進行積極持續餵養法。之前的文獻報導並未論述充分的腸道休息有助腸道康復。我們的病人是一名足月女嬰，在其出生後第三天因為腸扭轉進行了大部份腸切除術。當進行積極持續餵養時，患兒出現直腸出血和休克。經過腸道休息後，我們重新開始進行餵養，調整牛奶量來配合其剩餘腸道的長度。每兩小時進行通過注射器小劑量快速推注進食1次。間隔時間依據腸道黏膜蠕動時間而定。經口和靜脈兩種方式攝入營養的總熱量同其他嬰兒一樣，約為100 kcal/kg/day。在患兒9個半月時，腸道功能完全恢復，體重達到8.54 kg。患兒10個半月大時康復出院。在我們生理餵養策略中，管飼、促動力藥、止瀉藥、抗生素、益生菌、激素治療及重複的腸道手術都是不需要的。跟既往超短腸綜合症的推薦治療所不同的，是在整個治療過程中或在腸道功能恢復前積極的牛奶餵養是不需要的。