Newborns with massive intestinal loss: difficult choices.

Before total parenteral nutrition was possible, most infants with extensive intestinal loss died of starvation and infection. The ability to provide sufficient calories intravenously has permitted the survival of many infants with short intestines. For these patients, however, total parenteral nutrition has been viewed as a temporary, adjunctive therapy that allows the residual intestine time to undergo a complex adaptive process for sustaining enteral feeding. Infants with intestinal loss so massive as to make the possibility of enteral nutrition uncertain or unlikely pose an ethical dilemma. Consider the following case, of a neonate who had extensive loss of the small . . .