Nutr Clin Pract. 2025 Feb;40(1):188-194. doi: 10.1002/ncp.11232. Epub 2024 Nov 5.

Brittany DePaula ^1 2, Paul D Mitchell ³, E Reese ^1 2, Megan Gray ^1 2 4, Christopher P Duggan ^1 2

Author information

¹Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, Massachusetts, USA.

²Division of Gastroenterology, Hepatology and Nutrition, Center for Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

³Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, USA.

⁴Baxter International Inc, Deerfield, Illinois, USA.

Abstract

Background: Human milk and amino acid (AA) formulas are correlated with a shorter duration of parenteral nutrition (PN) dependence for infants with intestinal failure (IF). Literature to guide feeding practices beyond infancy in this population is limited. We aimed to assess PN dependence, growth patterns, and stool frequency in pediatric patients with IF who transitioned from AA or hydrolyzed formula to blenderized tube feedings (BTFs).

Methods: We performed a retrospective review among children with IF observed at Boston Children's Hospital from January 2014 to January 2019. Inclusion criteria were receipt of BTF for ≥3 months at a volume of ≥200 ml/day and ≥2 outpatient visits during the study period. Patients who received BTF in combination with another formula or food purees were excluded.

Results: Twelve children met criteria. Eleven had a small bowel resection with mean residual small bowel length of 51 ± 47 cm. Two retained their ileocecal valve (ICV), and eight had colonic resection. All patients were dependent on PN with mean (SD) energy intake of 51 ± 21 kcal/kg/day. After transition to BTF, three patients (25%) achieved enteral autonomy, and seven (58%) had a reduction in PN energy intake. Anthropometric data and stool frequency were generally unchanged.

Conclusion: The transition from AA or hydrolyzed formula to BTF was associated with a substantial reduction in PN support in 12 children with IF. Stool frequency and growth parameters were not significantly changed. Our findings suggest that the use of BTF in older children with IF should be considered.