You are called to see a 38-week gestational age newborn in the neonatal ICU. The family was previously seen in your office for prenatal consultation due to a concern for gastroschisis. On examination, you identify a closed gastroschisis defect. At time of operation, you determine that based on the length of the remaining small bowel (45cm), the child will likely have intestinal failure secondary to short gut syndrome. Which of the following may improve the child’s ability to wean from TPN?

[center][/center]

 

 

[size=20px]A Teduglutide

 

B Dexamethasone

 

C Reglan

 

D Loperamide

 

E Pantoprazole​[/size]

A

A.

A

A

A

Teduglutide is a glucagon-like peptide 2 (GLP-2) analog, has recently been approved for use in pediatric SBS patients greater than 1 year of age as a novel agent to augment intestinal adaptation

A

A

[b]A

a 33-membered polypeptide and glucagon-like peptide-2 (GLP-2) analog that is used for the treatment of short bowel syndrome[/b]

A

A

A

Correct answer

A Teduglutide

 

Intestinal failure secondary to short gut syndrome has been the subject of numerous studies. These studies support an aggressive approach to intestinal rehabilitation in order to allow for adaptation. A decrease in the need for parenteral nutrition and improvement in enteral autonomy remain the mainstays of management. Studies support early restoration of intestinal continuity. Predictors of long term success include the amount of residual bowel length, early enteral feeding, frequent monitoring of stool output, and a protocolized approach to feed advancement. Studies show that a multimodal and multidisciplinary approach to intestinal rehabilitation. These programs have shown an increased rate in weaning from TPN, higher survival, and lower rates of malnutrition.

 

Medical interventions to improve intestinal absorption have been an ongoing area of research. Recent studies have evaluated glucagon-like peptide-2 (GLP-2) analogues (such as teduglutide). This peptide is normally secreted by the enteroendocrine cells. Ongoing studies have shown its ability to increse epithelial proliferation, enhace gut barrier function, and increase microvillous length. Placebo-based studies inadult patients have shown an improvement in enteral feeds and a decrease in parenteral nutrition. Results from Phase II trials in the pediatric population have shown similar results to the early adult studies with similar safety and efficacy.

 

Intestinal lengthening and tapering procedures remain in the armamentarium of intestinal failure management. Children that are failing to grow, have an inability to wean from parenteral nutrition, and have persistently dilated bowel despite maximal medical therapy should be considered as candidates. Based on the success of intestinal rehabilitation programs, the role of small bowel transplantation continues to diminish.