Clinical assessment of the child with intestinal failure.pdf

CJ F M t ( t I r o c a o c i d t t i S d 1 d Seminars in Pediatric Surgery (2010) 19, 10-19linical assessment of the child with intestinal failure ason S. Soden, MD rom the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado Denver School of edicine and The Children’s Hospital, Aurora, Colorado.The management of the child with intestinal failure is complex, and it is developing into a multispe- cialty field of its own led by expert teams of both transplant and nontransplant surgeons, gastroenter- ologists, and dieticians. Patients are at risk for medical, surgical, and nutritional complications that should be anticipated so that they can be prevented or managed appropriately. Catheter associated infections and intestinal failure associated liver diseases are important complications that impact the likelihood of bowel adaptation and long-term survival. The clinical assessment of a pediatric intestinal failure patient should include evaluation of the child within the context of recognized prognostic factors. ? 2010 Elsevier Inc. All rights reserved. KEYWORDS Short bowel syndrome; Parenteral nutrition associated liver disease; Citrulline; Micronutrient deficiency; Catheter associated infectionI a T i a i t f i l ( s r v T d e t i IIntestinal failure (IF) is the end result of any disease state hat causes chronic dependence on total parenteral nutrition TPN) to maintain adequate growth, hydration, or micronu- rient balance. In pediatric patients, the primary etiology of F is short bowel syndrome (SBS) resulting from surgical esection of the small bowel. The goals in the management f an IF patient are to provide adequate nutrition for the hild to grow and develop normally and to promote bowel daptation while monitoring and treating the complications f the underlying disease and parenteral nutrition (PN). The linical assessment of a pediatric patient with IF must take nto account an understanding of the patient’s underlying isease, anth