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.