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Saving infants from transplant

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TWC News: Saving infants from transplant
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Short bowel syndrome is a health condition in which nutrients are not properly absorbed due to the surgical removal of a large portion of the small intestine or severe intestinal disease.

When areas of the small intestine are removed due to surgery, birth defects or disease, usually there is not enough surface area left in the bowel to absorb enough nutrients for someone to survive.

Most of the nutrients are absorbed and most of the food is digested in the small intestine. The main cause of short bowel syndrome is surgical removal of more than half of the small intestine due to dangerous intestinal diseases developed at birth. Newborns usually develop the syndrome when they are treated for diseases such as meconium ileus (associated with cystic fibrosis), congenital defects of the bowel (like gastroschisis, jejunoileal atresia, internal hernia, and congenital short bowel), or necrotizing enterocolitis (a condition that occurs in premature infants and leads to the death of bowel tissue).

The main treatment for short bowel syndrome is nutritional support. Treatment involves the use of oral parenteral nutrition, rehydration solutions, enteral nutrition and medications. Parenteral nutrition provides the patient with electrolytes, fluids and liquid nutrients directly into their bloodstream through an intravenous tube in their vein. Oral rehydration solutions involve salt and sugar liquids. Enteral nutrition provides the patient with liquid food to the small intestine through the use of a feeding tube.

Treatment depends on the severity of the disease. Patients who have a mild case have to eat small, frequent meals and take fluid and nutritional supplements. Those who have a moderate case of short bowel syndrome are similar to those who have a mild case, but have to undergo intravenous fluids and electrolyte supplements.

Patients who have a severe case have to use parenteral nutrition, oral hydration solutions and enteral nutrition. For those patients, where other solutions have failed them, may have to resort to intestinal transplantation.

Researchers are studying new ways to help the remaining small intestine function. A new multidisciplinary approach to the problem was developed called the Advanced Intestinal Rehabilitation Program. The Division of Pediatric Gastroenterology at the Miller School of Medicine, University of Miami, is one of the few in the country that has undergone the new approach.

Treatment consists mainly of specialized nutrition management aimed at helping the remaining intestines adapt and absorb nutrients. Before this program was created, the only option for these patients was intestinal or liver transplants.

Research has proven that the multidisciplinary approach is the most successful. To that extent, the program includes board certified pediatric gastroenterologist, transplant surgeons, pediatric surgeons, nurse practitioners, social workers, registered dietitian, pharmacists and child psychologists.

The program has increased the five-year survival rate from 60 to 80 percent.

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