Fiber Use in Pediatric Short Bowel Syndrome

Short bowel syndrome (SBS) is a form of disease that results from removal of a significant
portion of the intestine leading to poor nutrient absorption. Infants with short bowel
syndrome suffer from diarrhea and poor growth. The care of these infants is limited by the
lack of effective therapies. As the intestine tries to grow back some of its length, a
process that can take many months, these infants become dependent on intravenous (IV)
nutrition in order to survive. Liver disease and sepsis (a blood stream infection) are
common complications of IV nutrition and are the two most common causes of death in this
population. Therefore, clinicians have tried different ways to improve feeding and shorten
the amount of time of IV nutrition, for example continuous feedings through the intestine,
use of partly digested formulas and change in diet.

Soluble fiber (guar gum) is an indigestible form of sugar that is mostly contained in fruits
and vegetables. Soluble fiber can reduce the severity and duration of persistent (constant)
diarrhea in children.

The purpose of this research study is to evaluate the many effects of fiber added in the
diet of infants with SBS.

Pediatric infants (less than 1 y of age) who

1. Have Short Bowel Syndrome defined by a history of congenital or surgical loss of
intestinal absorptive function resulting in parenteral nutrition dependency of longer
than 30 days;

2. Are receiving at least 20% of their caloric needs from enteral nutrition and have
been on enteral nutrition for at least 1 week following intestinal resection;

3. Have increased stool output as manifested by watery stools (3-12/day) and increased
ostomy output (20-50 cc/kg/day);

4. Have not received antibiotics, probiotics or prebiotics for 2 weeks prior to study
entry;