How is malnutrition prevented following surgery for intestinal malrotation?

Updated: Dec 19, 2018
  • Author: Denis D Bensard, MD, FACS, FAAP; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Nutrition in the postoperative period is as follows:

  • In the immediate postoperative period, the time to return of bowel function depends on the duration of obstruction and extent of bowel compromise. [37]

  • Most patients require total parenteral nutrition until full oral feedings can be reestablished and should have a central venous catheter placed.

  • Patients may also require intravenous infusion of amino acid solutions to achieve positive nitrogen balance.

  • Adequate nutrition is essential to ensure wound healing and protect from bacterial overgrowth.

  • Infants who are malnourished have longer recovery time.

  • Patients should receive full nutritional support with parenteral nutrition until they are able to consume at least 50% of daily caloric requirement. Parenteral nutrition can then be weaned slowly as full enteral intake is achieved.

Strategies to improve nutrition and considerations for short bowel syndrome are as follows:

  • Enteral feeding can be initiated with elemental formula. In the initial postoperative period, absorptive surface area and enzyme activity are decreased. Volume and concentration of feeds can be advanced as absorptive capacity increases.

  • Infants who undergo extensive small bowel resection are at risk of developing short bowel syndrome. These infants may require long-term parenteral nutrition until the remaining bowel is able to adapt and undergo compensatory growth. In these children, feeding should be initiated with small amounts of enteral nutrition to encourage adaptation of the bowel and provide nutrition for the mucosa. Gastrostomy tube placement may be helpful in this situation and should be assessed on a case-by-case basis. [37]


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