Effects of dietary fish oil on intestinal adaptation in 20-day-old weanling rats after massive ileocecal resection

Intestinal Failure in a Neonate: A Surgical Emergency and Medical Catastrophe

In this case report, we present a female neonate referred to us, born to a primigravida mother at 39 weeks, who cried after birth, did not require any resuscitation, had a birth weight of 2.9 kg and developed abdominal distension and bilious vomiting on Day 1 of life. Ultrasound abdomen and X-ray imaging were suggestive of midgut volvulus with malrotation. The emergency explorative laparotomy revealed the small bowel to be gangrenous in extensive areas, and 10 cm of the small intestine was successfully preserved. The baby was admitted to the NICU and required three months of total parenteral nutrition. In between, the baby was managed successfully for sepsis, septic shock, diarrhea, and dehydration, Later, she was discharged, and is currently being followed up. At the first follow-up, the baby was noted to be gaining weight and has developed no complications to date.

Randomized controlled trial of early enteral fat supplement and fish oil to promote intestinal adaptation in premature infants with an enterostomy

OBJECTIVE

To test the hypothesis that early enteral supplementing fat and fish oil decreases the duration of parenteral nutrition (PN) and increases enteral nutrition (EN) before bowel reanastomosis in premature infants with an enterostomy.

STUDY DESIGN

Premature infants (<2 months old) who had an enterostomy and tolerated enteral feeding at 20 mL/kg/day were randomized to usual care (control=18) or early supplementing enteral fat supplement and fish oil (treatment=18). Intravenous lipid was decreased as enteral fat intake was increased. Daily weight, clinical and nutrition data, and weekly length and head circumference were recorded. The primary outcomes were the duration of PN and volume of EN intake, and the secondary outcomes were weight gain (g/day), ostomy output (mL/kg/d), and serum conjugated bilirubin level (mg/dL) from initiating feeding to reanastomosis. Data were analyzed by Student t test or Wilcoxon rank sum test.

RESULTS

There were no differences in the duration of PN, ostomy output, and weight gain between the 2 groups before reanastomosis. However, supplemented infants received less intravenous lipid, had greater EN intake, and lower conjugated bilirubin before reanastomosis, and they also received greater total calorie, had fewer sepsis evaluations and less exposure to antibiotics and central venous catheters before reanastomosis, and had greater weight and length gain after reanastomosis (all P<.05).

CONCLUSION

Early enteral feeding of a fat supplement and fish oil was associated with decreased exposure to intravenous lipid, increased EN intake, and reduced conjugated bilirubin before reanastomosis and improved weight and length gain after reanastomosis in premature infants with an enterostomy.

Early enteral fat supplementation improves protein absorption in premature infants with an enterostomy

BACKGROUND

Early enteral fat supplementation and fish oil (FO) stimulates post-resection intestinal adaptation in rats and increases fat absorption in premature infants with bowel resection and an enterostomy.

OBJECTIVE

To test the hypothesis that early fat supplement and FO increases post-resection protein absorption, intestinal RNA, protein without decreasing intestinal arachidonic acid (AA) in premature infants with an enterostomy.

METHODS

36 premature infants (<2 months old) with an enterostomy after surgical treatment for necrotizing enterocolitis or spontaneous intestinal perforation who tolerated enteral feeding at 20 ml/kg/day were randomized to usual care (control, n = 18) or early supplementing enteral Microlipid (ML) and FO (treatment, n = 18). Intralipid was decreased as the dose of enteral fat was increased. Daily weight, ostomy output and nutritional intake were recorded. Weekly 24-hour ostomy effluent was collected to measure fecal protein. Protein absorption was calculated by subtracting fecal protein from dietary protein. Tissue samples from the functional stoma and the nonfunctional distal diverted end were collected during bowel reanastomosis to measure RNA, protein, and fatty acid (FA) profile.

RESULTS

Compared to controls, the treatment group had higher protein absorption (g/kg/day) and intestinal RNA and protein (μg/mg tissue) proximal to the ostomy. The two groups had similar FA profiles except that the treatment group had higher n-3 eicosapentaenoic acid (EPA, μg/mg tissue) proximal to the ostomy.

CONCLUSION

Early supplementation of enteral ML and FO to premature infants with an enterostomy increased dietary protein absorption, intestinal RNA, protein and n-3 EPA content without altering other FA content.

Early enteral fat supplement and fish oil increases fat absorption in the premature infant with an enterostomy

OBJECTIVE

To test the hypothesis that in the premature infant with an enterostomy, early enteral supplementation with Microlipid (fat supplement) and fish oil increases enteral fat absorption and decreases the requirement for Intralipid (intravenous fat emulsion).

STUDY DESIGN

Premature infants (<2 months old) with an enterostomy after surgical treatment for necrotizing enterocolitis or spontaneous intestinal perforation and tolerating enteral feeding at 20 mL/kg/day were randomized to usual care (control 18 infants) or early supplementing enteral fat and fish oil (treatment 18 infants). Intravenous fat emulsion was decreased as enteral fat intake was increased. Daily weight, ostomy output, and nutrition data were recorded. Weekly 24-hour ostomy effluent was collected until bowel reanastomosis, and fecal fat, fecal liquid, and dry feces were measured. Fat absorption (g/kg/d) was calculated by subtracting fecal fat from dietary fat. The fecal liquid and dry feces were reported as mg/g wet stool. Date were analyzed by using ANOVA and mixed-effects model.

RESULTS

The interval from initial postoperative feeding to bowel reanastomosis varied from 2 to 10 weeks. The treatment group received more dietary fat and less intravenous fat emulsion and had higher enteral fat absorption, less fecal liquid, and drier feces than the control group. These effects were greater among infants with a high ostomy compared with those with a low ostomy. Enteral fat intake was significantly correlated with fat absorption.

CONCLUSION

Early enteral fat supplement and fish oil increases fat absorption and decreases the requirement for intravenous fat emulsion. This approach could be used to promote bowel adaptation and reduce the use of intravenous fat emulsion in the premature infant with an enterostomy.

A review of enteral strategies in infant short bowel syndrome: evidence-based or NICU culture?

INTRODUCTION

Short bowel syndrome (SBS) is an increasingly common condition encountered across neonatal intensive care units. Improvements in parenteral nutrition (PN), neonatal intensive care and surgical techniques, in addition to an improved understanding of SBS pathophysiology, have contributed in equal parts to the survival of this fragile subset of infants. Prevention of intestinal failure associated liver disease (IFALD) and promotion of intestinal adaptation are primary goals of all involved in the care of these patients. While enteral nutritional and pharmacological strategies are necessary to achieve these goals, there remains great variability in the application of therapeutic strategies in units that are not necessarily evidence-based.

MATERIALS AND METHODS

A search of major English language medical databases (SCOPUS, Index Medicus, Medline, and the Cochrane database) was conducted for the key words short bowel syndrome, medical management, nutritional management and intestinal adaptation. All pharmacological and nutritional agents encountered in the literature search were classified based on their effects on absorptive capacity, intestinal adaptation and bowel motility that are the three major strategies employed in the management of SBS. The Oxford Center for Evidence-Based Medicine (CEBM) classification for levels of evidence was used to develop grades of clinical recommendation for each variable studied.

RESULTS

We reviewed various medications used and nutritional strategies included soluble fiber, enteral fat, glutamine, probiotics and sodium supplementation. Most interventions have scientific rationale but little evidence to support their role in the management of infant SBS. While some of these agents symptomatically improve diarrhea, they can adversely influence pancreatico-biliary function or actually impair intestinal adaptation. Surgical anatomy and liver function are two important variables that should determine the selection of pharmacological and nutritional interventions.

DISCUSSION

There is a paucity of research investigating optimal clinical practice in infant SBS and the little evidence available is consistently of lower quality, resulting in a wide variation of clinical practices among NICUs. Prospective trials should be encouraged to bridge the evidence gap between research and clinical practice to promote further progress in the field.

Dietary fish oil increases fat absorption and fecal bile acid content without altering bile acid synthesis in 20-d-old weanling rats following massive ileocecal resection

INTRODUCTION

Dietary fish oil (FO) was reported to lower fecal fat excretion in a weanling rat model of short bowel syndrome (SBS) after ileocecal resection (ICR), and to induce changes in secretion and synthesis of bile acid (BA) in adults. We hypothesized that dietary FO, as compared with corn oil (CO), increases intestinal fat absorption in weanling SBS rats in part due to increased hepatic BA synthesis and luminal BA concentrations.

METHODS

After undergoing ICR, 20-d-old rats were fed ad lib for 7 d with a CO or FO diet containing 5% sucrose polybehenate (SPB), a marker for dietary fat absorption. Fecal fatty acid, fecal and intestine luminal BA, liver mRNA expressions of cholesterol 7α-hydroxylase (Cyp7α1) and sterol-12α-hydroxylase (Cyp8β1), and serum 7α-hydroxy-4-cholesten-3-1 (7αC4) levels were determined.

RESULTS

As compared with CO-ICR rats, FO-ICR rats had higher intestinal absorption of total fat and most individual fatty acids. Although the BA content per gram of dry stool was increased in FO-ICR rats, there were no differences between groups for the BA content in remnant jejunum, liver mRNA expression of BA biosynthetic enzymes, Cyp7α1 and Cyp8β1, or serum 7αC4, a marker for BA synthesis.

CONCLUSION

Dietary FO increases dietary fat absorption without increasing hepatic BA synthesis in weanling SBS rats.