Nutrition Management in Pediatric Small Bowel Transplant

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Fifty-five children received intestinal transplants (ITx) at the Children's Hospital of Pittsburgh between July 1990 and January 1997. We assessed 23 children who had at least 1 year of follow-up with functioning intestinal grafts (7 isolated small bowel, 13 liver/small bowel, and 3 multivisceral) for nutritional status, linear growth, and weight gain. We divided the children into 4 groups by age: infants <1 year (n = 4), toddlers 1-5 years (n = 6), preadolescents 5-10 years (n = 6), and adolescents 10-18 years (n = 7). We began an appropriate elemental formula at an average of 15 days post-ITx (median, 13 days). At 1-year post-ITx, 15 children (65%) were thriving on oral diets, 7 children (31%) required enteral tube feedings that were secondary to oral aversion, and 1 child (4%) received partial parenteral nutrition support. Anthropometric data showed linear growth, appropriate weight in relation to height, and maintenance of fat and muscle stores. Serum albumin increased oneyear post-ITx in each age group. Serum zinc and red blood cell (RBC) folate levels were commonly found to be abnormal post-ITx.

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