Intestinal failure

Pediatric intestinal failure (IF) is an increasingly encountered complex condition in which the intestinal tract is unable to absorb the required amount of fluids and energy to maintain normal growth and development. Pediatric IF is most commonly due to short bowel syndrome (SBS) resulting from surgical resection for congenital or acquired gastrointestinal diseases. Other causes of IF are intestinal dysmotility syndromes and enteropathies. Patients with IF require long-term parenteral nutrition (PN) support and individualized multidisciplinary management while intestinal adaptation enables gradual achievement of enteral autonomy (i.e. weaning off PN) in most. Although recent advances in IF patient care have led to significant improvements in overall morbidity and mortality, these patients continue to be at risk for multiple complications, including IF-associated liver disease (IFALD), recurrent septic episodes, central line complications, intestinal bacterial overgrowth, metabolic bone disease, impaired renal function, failure to thrive, neurocognitive impairment and decreased quality of life (QoL). In this chapter we will discuss the etiology, pathophysiology, related complications, prognosis and treatment options of pediatric IF.