Intensive Care for Short Bowel Syndrome in Children: a Review

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Abstract

Short bowel syndrome is one of the most challenging conditions in modern pediatric surgery and intensive care, leading to a significant decrease in quality of life, disability, and mortality. This review presents current insights into the pathogenesis, clinical manifestations, diagnosis, and treatment of the condition. Publications focused on the principles of intensive care for pediatric short bowel syndrome were analyzed. Scientific data searches were conducted in the PubMed, Cochrane Central Register of Controlled Trials, eLIBRARY.RU, and CyberLeninka databases for the period from 2001 to December 2024. The search was conducted using the following keywords: синдром короткой кишки / short bowel syndrome, дети/pediatric, интенсивная терапия / intensive care, парентеральное питание / parenteral nutrition, энтеральное питание / enteral nutrition, and осложнения/complication. Inclusion criteria were studies describing the definition, clinical course, and intensive care principles of short bowel syndrome in children. Publications focused solely on adult patients were excluded, except for guidelines illustrating general intensive care principles applicable regardless of age. A total of 62 articles were included. The review discusses the definition, epidemiology, etiology, key risk factors, and pathogenesis of short bowel syndrome, as well as its classification and clinical presentation depending on the extent of intestinal resection. Particular attention is given to intensive care measures and nutritional support, the use of antibiotics and medications for restoring gut microbiota, glucagon-like peptide-2 analog therapy, and chyme reinfusion techniques. The core principles of nutritional support, indications and contraindications for its administration, and complications of long-term parenteral nutrition are examined. Strong evidence is presented supporting early initiation of enteral feeding. Functional gastrointestinal assessment tools and food tolerance diagnostics are described, along with suggested algorithms for initiating enteral support and managing short bowel syndrome–associated diarrhea. The necessity of a multidisciplinary approach for the early rehabilitation of children with short bowel syndrome is emphasized, aimed at restoring physiological function and development.

About the authors

Ekaterina A. Plevako

St. Mary Magdalene Children’s Hospital No. 2

Email: katerondo@mail.ru
ORCID iD: 0009-0001-5804-5020
SPIN-code: 9744-9205
Russian Federation, Saint Petersburg

Konstantin V. Pshenisnov

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: Psh_K@mail.ru
ORCID iD: 0000-0003-1113-5296
SPIN-code: 8423-4294

MD, Dr. Sci. (Medicine), Associate Professor

Russian Federation, Saint Petersburg

Yuri S. Alexandrovich

Saint Petersburg State Pediatric Medical University

Email: jalex1963@mail.ru
ORCID iD: 0000-0002-2131-4813
SPIN-code: 2225-1630

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Igor A. Komissarov

Saint Petersburg State Pediatric Medical University

Email: komissarov_i_a@mail.ru
ORCID iD: 0009-0000-5464-4627
SPIN-code: 3356-9330

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

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