Olieman Joanne Frederike, Penning Corine, Ijsselstijn Hanneke, Escher Johanna C, Joosten Koen F, Hulst Jessie M, Tibboel Dick
Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
J Am Diet Assoc. 2010 Mar;110(3):420-6. doi: 10.1016/j.jada.2009.12.001.
The optimal enteral feeding regimen in children with short-bowel syndrome (SBS) is debated by clinicians. The purpose of this article is to present an overview of published data on feeding strategies in children with SBS. A structured literature search (years 1966 through 2007) was done to identify human studies in children directly addressing nutrition (or specified nutrients) in relation to SBS. Eight relevant studies retrieved were graded by seven experts according to the Scottish Intercollegiate Guidelines Network criteria. This grading system is based on the study design and methodological quality of individual studies. Recommendations were made based on the outcome according to the Scottish Intercollegiate Guidelines Network if appropriate and on expert opinion otherwise. The most important recommendations are: Enteral nutrition should be initiated as soon as possible after bowel resection to promote intestinal adaptation. Enteral nutrition should be administered in a continuous fashion. Breast milk or standard polymeric formula (depending on the child's age) is recommended as preferred type of nutrition. Bottle-feeding (small volumes) should be started as soon as possible in neonates to stimulate the suck and swallow reflexes. Solid food can be introduced at the age of 4 to 6 months (corrected for gestational age if necessary) to stimulate oral motor activity and to avoid feeding aversion behavior. The team of experts concluded that high-quality research on the preferred types of enteral and oral nutrition in children with SBS is scarce. Multicenter prospective studies on the effects of feeding strategies on bowel adaptation, fecal production, linear growth, and clinical outcome are required to find the optimal feeding regimen in children with SBS.
临床医生对短肠综合征（SBS）患儿的最佳肠内喂养方案存在争议。本文旨在概述已发表的关于SBS患儿喂养策略的数据。进行了结构化文献检索（1966年至2007年），以确定直接针对与SBS相关的营养（或特定营养素）的儿童人体研究。七名专家根据苏格兰跨学院指南网络标准对检索到的八项相关研究进行了分级。该分级系统基于个体研究的设计和方法质量。根据苏格兰跨学院指南网络的结果在适当情况下提出建议，否则根据专家意见提出建议。最重要的建议是：肠切除术后应尽快开始肠内营养，以促进肠道适应。肠内营养应以持续方式给予。建议首选母乳或标准聚合配方奶（取决于儿童年龄）作为营养类型。新生儿应尽快开始奶瓶喂养（少量），以刺激吸吮和吞咽反射。可在4至6个月龄（必要时根据胎龄校正）引入固体食物，以刺激口腔运动活动并避免喂养厌恶行为。专家小组得出结论，关于SBS患儿首选肠内和口服营养类型的高质量研究很少。需要进行多中心前瞻性研究，以探讨喂养策略对肠道适应、粪便产生、线性生长和临床结局的影响，从而找到SBS患儿的最佳喂养方案。
