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Uptodate Reference Title
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.