Nutrition Interventions for Children with Special Health Care Needs

Chapter 20
Section 3 - Condition-Specific Nutrition Interventions
Nutrition Interventions for Short Bowel
Syndrome
Lori Brizee, MS, RD, CSP, LD
Definition of Short Bowel Syndrome
Short Bowel Syndrome (SBS) is defined as malabsorption resulting from anatomical
or functional loss of a significant length of the small intestine. This occurs most
commonly after bowel resection in the newborn period (e.g., secondary to necrotizing
enterocolitis, mid-gut volvulus, gastroschisis, or intussusception). SBS can also result
from trauma to the bowel (e.g., with an auto accident or fall, or with severe nonaccidental
trauma). The amount of bowel that must be lost to produce malabsorption
is variable and depends on which sections are lost and whether or not the ileocecal
valve is preserved. The normal length of small intestine is approximately 300-850 cm
for an adult, 200-250 cm for an infant over 35 weeks gestation, and approximately
100-120 cm for a premature infant less than 30 weeks gestation. Loss of greater
than 80% of the small bowel is associated with increased requirement for parenteral
nutrition support and decreased overall survival. When the ileocecal valve is lost,
the resulting risk for bacterial contamination of the small intestine from the colon
mandates more small intestine for tolerance of oral/enteral feeding (1,2,3).
The small intestine consists of the duodenum, jejunum, and ileum. (See Figure 1)
The majority of carbohydrate and protein absorption takes place in the duodenum
and jejunum. Fats and fat-soluble vitamins are absorbed in the ileum. Bile salts are
excreted from the liver into the duodenum and are required for the absorption of long
chain fatty acids and fat-soluble vitamins in the ileum. Vitamin B12 binds to intrinsic
factor (produced in the stomach) and is absorbed in the terminal ileum. Fluids and
electrolytes are predominantly absorbed in the ileum and in the colon. When the
duodenum and/or jejunum are resected, the ileum can largely adapt to perform their
absorptive functions. The duodenum and jejunum, however, cannot adapt to perform
the functions of the ileum. Thus, resection of the duodenum or jejunum is generally
much better tolerated than resection of the ileum.
The ileocecal valve is the main barrier between the small and large intestine. It helps
regulate the exit of fluid and malabsorbed nutrients in small bowel. It also helps
Nutrition Interventions for Children With Special Health Care Needs 227