Nutritional Approach of Neonatal with High Output Stoma Due to Long Segment Hirschsprung Disease: A Case Report

Authors

  • Aris Primadi Neonatology Division, Department of Child Health, Faculty of Medicine Padjadjaran University, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
  • Filla Reviyani Suryaningrat Neonatology Division, Department of Child Health, Faculty of Medicine Padjadjaran University, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

DOI:

https://doi.org/10.58427/apghn.2.3.2023.33-8

Keywords:

high output stoma, hirschsprung, neonatal, nutrition

Abstract

Background: High Output Stoma (HOS) continues to be one of the most challenging problems for pediatrician especially in neonates. One of the most common causes in neonatal HOS is post resection long segment Hirschsprung disease.

Case: We reported a case of three-day-old baby boy diagnosed as Hirschsprung diseases with peritonitis possibility and did laparotomy with ileal resection, double barrel ileostomy and biopsy. Nutritional management is a major subject on taking care of this type of neonatal patient. We share our experience in limited facilities with all the patient uniqueness

Discussion: Loss of a significant length of the small bowel results in interrelated physiologic events as a result of decreased small intestinal mucosal absorptive cell. This leads to a lesser fraction of ingested food and intestinal secretion thus causing an excessive volume loss. The introduction of early enteral feeds promotes intestinal adaptation, with subsequent weaning off parenteral nutrition. Most off patient with high output stoma will require parenteral nutrition which is associated with acute and long-term complications. In our case, we did early nutritional intervention using parenteral and enteral nutrition, counting ongoing fluid loss trough stoma and adjust it to total daily fluid requirement. We found weight loss during hospitalized due to HOS, and we do catch up at the end. We found difficulties to adjust comparation between enteral and parenteral intake to maintain the weight gain.

Conclusion: Although parenteral nutrition is often necessary, at least initially, the therapeutic goal should be to enhance intestinal adaptation and enteral nutrient assimilation, and thereby reduce parenteral nutrition requirements. Daily monitoring for ongoing fluid loss very crucial for adjusting nutrition.

References

Crealey M, Walsh M, Awadalla S, Murphy JF. Managing newborn ileostomies. Ir Med J. 2014;107(5):146-8

Bindi E, Molinaro F, Ferrara F, Fusi G, Taddei A, Sica M, et al. Recycling of Stoma Losses: A Good Practice for Neonates with High Output Stomas—Our Experience and Comparison with Literature. Journal of Neonatology.2020;34(4):181-6. https://doi.org/10.1177/0973217920977245 DOI: https://doi.org/10.1177/0973217920977245

Mansour F, Petersen D, De Coppi P, Eaton S. Effect of sodium deficiency on growth of surgical infants: a retrospective observational study. Pediatr Surg Int. 2014;30(12):1279-84.https://doi.org/10.1007/s00383-014-3619-2 DOI: https://doi.org/10.1007/s00383-014-3619-2

Koike Y, Uchida K, Nagano Y, Matsushita K, Otake K, Inoue M, et al. Enteral refeeding is useful for promoting growth in neonates with enterostomy before stoma closure. J Pediatr Surg. 2016;51(3):390-4.https://doi.org/10.1016/j.jpedsurg.2015.08.058 DOI: https://doi.org/10.1016/j.jpedsurg.2015.08.058

Radbone L, Hoodbhoy S, Narayanan S, King MK. East of England Neonatal Network Enteral Feeding of Preterm Infants on the Neonatal Unit.

Published

2023-08-31

How to Cite

1.
Nutritional Approach of Neonatal with High Output Stoma Due to Long Segment Hirschsprung Disease: A Case Report. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2023 Aug. 31 [cited 2025 Mar. 15];2(3):33-8. Available from: https://apghn.com/index.php/journal/article/view/46

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