Research Status of Neonatal Intestinal Failure

Dear Colleagues,

Neonatal short bowel syndrome is a disease with a high morbidity and mortality, and is the leading cause of intestinal failure in this age group. Neonatal intestinal failure (IF) is the critical reduction of the gut mass or its function below the minimum needed to absorb nutrients and fluids required for adequate growth in children. Severe IF requires parenteral nutrition (PN). Pediatric IF is most commonly due to congenital or neonatal intestinal diseases or malformations, divided into three groups: 1) reduced intestinal length and consequently reduced absorptive surface as in short bowel syndrome (SBS) or extensive aganglionosis; 2) abnormal development of the intestinal mucosa, as in congenital diseases of enterocyte development; 3) extensive motility dysfunction, such as chronic intestinal pseudo-obstruction syndromes.

Novel approaches developed through multidisciplinary teamwork, such as the manipulation of the microbiome or tissue bioengineering, should be added to current therapies to successfully treat SBS.

Fields of research:

1) Recent studies indicate that the early postnatal period is a critical window for gut microbiome manipulation to optimize the immunity and body growth. Investigating the maternal fecal microbiome and the link to the development of the intestinal mucosal immune system of the babies is an emerging area.

2) Approximately 25% of children with short bowel syndrome (SBS) experience food aversion (FA), which can have implications for weaning off parenteral nutrition (PN). Food aversion and the role of play therapy to overcome this issue requires research.

3) Determining the prevalence of specific micronutrient (iron, zinc, magnesium, phosphorus, selenium, copper, folate, vitamins A, D, E, and B12) deficiencies in children with intestinal failure (IF) and identification of the risk factors associated with development of such.

4) Liver disease is more common in infants and neonates than in adults, suggesting that the neonatal liver may be more susceptible to injury. The risk factors for liver-related intestinal failure can be divided into two categories: patient-related and PN-related factors.

5) The bioengineering of tissues and organs to repair, replace, and regenerate intestine is emerging as a science. State-of-the-art regenerative medicine can present the possibility of creating ex-vivo intestine.

Dr. Antonino Morabito
Guest Editor

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• Neonatal Intestinal Failure
• Food Aversion
• Regenerative Medicine