Management of Short Bowel Syndrome After Necrotizing Enterocolitis

Short bowel syndrome is a common complication following lifesaving intestinal resection for NEC and results in an inability of the child to absorb adequate enteral nutrients to sustain growth. The advent of parenteral nutrition in the 1960s changed what was previously a universally fatal diagnosis to a chronic treatable condition, and our understanding of the disease process and management strategies have evolved considerably over the ensuing decades. While parenteral nutrition remains the mainstay of nutritional support in the early stages, the goal of care is to facilitate intestinal adaptation in order to achieve enteral autonomy, while minimizing complications such as intestinal failure–associated liver disease, central line–associated bloodstream infections, intestinal dysbiosis, and sepsis. Early enteral feed initiation with protocolized advancement is critical, and a variety of pharmaceutical and surgical adjunctive therapies are now available to increase the absorptive capacity of the bowel and minimize complications. Multidisciplinary intestinal rehabilitation programs bring together specialists across disciplines to work collaboratively and achieve improved outcomes. As our understanding of the pathophysiology of short bowel syndrome continues to evolve, new therapeutic options, such as drugs targeted to augment intestinal adaptation and tissue-engineered bowel, have tremendous potential to improve outcomes and quality of life for these challenging patients.