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Guiding principles for advancing feeds during inpatient care of an infant with short bowel syndrome

Guiding principles for advancing feeds during inpatient care of an infant with short bowel syndrome
Principle 1 Quantify feeding intolerance primarily by stool or ostomy output, and hydration status.
Principle 2 Tolerance assessed no more than twice per 24 hours; no more than one advancement in feeds per 24-hour period.
Principle 3 Typical enteral feeding goal are 150 to 200 mL/kg/day, and 100 to 140 kcal/kg/day, provided that weight gain is adequate.
Principle 4 If ostomy or stool output precludes advancement at 20 kcal/ounce for 7 days, then the caloric density of the formula may be increased.
Principle 5 Reductions in parenteral nutrition support should be undertaken simultaneously with feeding advancement, provided that weight gain is adequate.
Adapted from: Brenn M, Gura K, Duggan C. Intestinal failure. In Sonneville K, Duggan C (eds), Manual of Pediatric Nutrition (5th ed.). People's Medical Publishing House – USA, Shelton, CT, 2013.
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