Pediatric Intestinal Failure

Intestinal failure happens when the small intestine can’t properly absorb nutrients, vitamins and water from food. Some babies are born with missing or dysfunctional small intestines, for which they may need surgery.

In children, intestinal failure can lead to malnourishment, poor growth, problems with the liver, kidneys, and gallbladder, and other complications.

The most common cause of intestinal failure is short bowel syndrome, which usually happens when a large part of the small intestine has been damaged or surgically removed. Babies who are at risk for intestinal failure usually have had surgery for one of the following problems:

• Born with intestines outside the body (gastroschisis)
• Born with narrowed or blocked intestines (atresia)
• Born with problems in the intestinal lining
• Inflammation and infection in the intestines (necrotizing enterocolitis)
• Crohn disease
• Twisting of the intestine (volvulus)

Two other major causes of intestinal failure are:

• Neuromuscular problems in the intestines, preventing the muscles from moving stool through the intestines properly
• Congenital diseases of the intestinal lining, causing poor absorption of nutrients and malnutrition

Common symptoms of intestinal failure include:

• Severe diarrhea
• Poor growth or weight loss
• Abdominal bloating
• Loss of appetite
• Dehydration
• Sepsis (severe blood infection)

If your baby has had intestinal surgery and shows any of these symptoms, the pediatrician may request one or more of the following tests to determine the cause:

• Blood tests to check vitamin and mineral levels for evidence of malnutrition
• Blood cultures to check for bacterial infection (sepsis) or fungal infection
• Diagnostic imaging, including CT and ultrasound scans, to evaluate the liver, spleen, kidneys and bowels
• X-rays to check for bowel obstructions

Children with intestinal failure need proper nutrition and fluids to replace those lost to poor absorption. Among the treatment options are:

• Total parenteral nutrition (TPN, or nutrition through veins) soon after diagnosis
• Transition to home enteral feeding (through the intestines) to minimize the risk of infections and liver damage from TPN
• Enteral (intestinal) nutrition of special formula through a feeding tube
• Advanced, non-transplant surgical options, including bowel-lengthening surgery

Intestinal transplants for children who can’t wean off the TPN

Learn more about our comprehensive Intestinal Rehabilitation Program at Children’s National Hospital.