Protocol for advancing feeds during inpatient care of an infant with short bowel syndrome
Protocol for advancing feeds during inpatient care of an infant with short bowel syndrome
* Contraindications to enteral feeding:
Ileus, grossly bloody stools or ostomy output, or radiologic changes suggesting intestinal ischemia
Shock/poor perfusion due to cardiac or respiratory insufficiency
Bilious and/or persistent vomiting (>3 episodes in 12 hours)
Clinical suspicion of obstruction or ileus (severe distension, decreased ostomy output and/or radiologic changes suggesting obstruction or ileus)
¶ Assess tolerance 1 to 2 times in each 24-hour period. Advance feeds no more than once in each 24-hour period. Δ Depending on the patient and clinical setting, stool output can be monitored as number of stools each day, or stool weight (grams/day), or ostomy output (mL/kg/hour). Any one of these measures can be used for this algorithm. ◊ To hold feeds; the usual approach is to stop feeds for 8 hours, then restart at 75% of the previous rate.
Adapted from: Brenn M, Gura K, Duggan C. Intestinal failure. In: Manual of Pediatric Nutrition, 5th ed, Sonneville K, Duggan C (Eds), People's Medical Publishing House, Shelton, CT 2013.