Journal of Neonatal Surgery | Year: 2023 | Volume: 12 | Page ID: 8 Short Bowel Syndrome in neonates and early infancy Shivani Dogra, Nitin James Peters, * Ram Samujh Postgraduate Institute of Medical Education and Research Chandigarh India Correspondence*: Nitin James Peters, Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail: nitinjamespeters@yahoo.com KEYWORDS ABSTRACT Short bowel, Enteral nutrition, Parenteral nutrition, Intestinal adaptation Short bowel syndrome (SBS) is the commonest cause of intestinal failure in neonates. SBS results from widespread damage to the small intestine, leading to loss of functional capacity of this organ. This is generally secondary to conditions like necrotizing enterocolitis, gastroschisis, intestinal atresia, and midgut volvulus. The small bowel usually adapts to this damage in due course of time. The clinician's role usually entails the management of parenteral nutrition and the fluid and electrolyte balance to tide over this phase. The management should be initiated as soon as the diagnosis is suspected, especially post- surgical resection of the bowel. This should comprise enteral nutrition, with proactive monitoring and supplementation of electrolytes and micronutrients. Intestinal lengthening procedures like the Serial transverse enteroplasty (STEP), and Longitudinal intestinal lengthening and tailoring (LILT) may be considered in infants, where medical therapy fails to correct the pathology. The intricate nature of the condition warrants a multi-disciplinary approach, involving clinicians, intensivists, and surgeons, which ensures the best neonatal outcomes, in terms of the survival rates in these babies. INTRODUCTION Short bowel syndrome (SBS) is a malabsorptive condi- tion, characterized by an extensive loss of intestinal mass, secondary to a congenital or acquired disease. The intestine usually adapts to this loss, typically af- ter surgical resection. This involves alterations, both at the macro and microscopic levels, basically target- ed at increasing the absorptive potential of the re- maining portion of the small bowel. However, this adaptogenic response takes time to get established, and the intervening period becomes critical. Parenter- al nutrition (PN) is the cornerstone in wading off this period, by providing sufficient time for the body to adapt and recalibrate its functional capacity. There are several studies that prove that PN is critical in achieving enteral autonomy. [1,2] Advances in medi- cal and surgical management have resulted in re- duced mortality and better outcomes in neonates with SBS. [3] These include corrective steps like adding several micronutrients to feeds for neonates and in- fants and precise calculation and reconstitution of parenteral nutrition using aseptic techniques like the laminar flow chamber. Advances in neonatal critical care have changed the scenario for babies with short bowel even in LMICs and resource-challenged na- tions. Better anesthesia techniques and perioperative advances have encouraged surgeons to perform bowel restoration and bowel lengthening procedures more frequently. Definition of SBS Pediatric intestinal failure (PIF) has been defined by the American Society for Parenteral and Enteral Nu- trition (ASPEN) as “The reduction of functional intes- tinal mass below that which can sustain life, resulting in dependence on supplemental parenteral support for a minimum of 60 days within a 74 consecutive day interval”. [4] Intestinal failure encompasses various disorders including surgical short-bowel syndrome, as well as gastrointestinal motility disorders (Long seg- ment Hirschsprung disease, Intestinal pseudo- obstruction) and congenital mucosal abnormalities (Microvillus inclusion disease, Tufting enteropathy). There are multiple SBS definitions in vogue in the literature, and this lack of a uniform definition ren- ders the comparison and compilation of various stud- ies a particularly arduous task. SBS may be defined anatomically based on the amount of residual small intestine remaining or by the duration of PN depend- ency. The recommended definition of SBS as per the Review Article © 2023 Dogra et al Submitted: 17-10-2022 Accepted: 06-12-2022 License: This work is licensed under a Creative Commons Attribution 4.0 International License. DOI: https://doi.org/10.47338/jns.v12.1148