Bennie Wayne

This is something said often in dietetics and a philosophy used with many patients that I had worked with in the past. If the body is able to tolerate and absorb some nutrition through the gastrointestinal tract, then it is best for the body to use that method. Sometimes the gut works, but not enough to meet all the nutrition needs for growth. I never thought I would find myself over analyzing and constantly rethinking this process for my own baby.

Bennie lost a lot of her small intestine – almost half of what she had and almost her entire ileum. She is still able to take breast milk into her stomach, then duodenum, then jejunum, where the process of digestion occurs and absorption can begin. The difficulty right now is that she does not have a lot of total length of small intestine for the nutrients to absorb – so the partially digested/partially absorbed contents come out into her jejunostomy bag. So far, with really small volumes of breast milk, she seems to be tolerating this process without any major signs of discomfort. The surgeon feels at this time that we cannot count any more than 50% of the calories she is getting from breast milk because of the poor absorption. She continues to get 100% of her nutrition needs from IV nutrition (TPN), and there is a good chance she will continue to need TPN when she comes home.

Re-feeding into the colon

In order to help stimulate all of Bennie’s intestine, we are now doing a process called re- feeding. The partially absorbed fluid that comes out of Bennie’s jejunostomy is collected with a syringe and then is slowly pumped through a tube into her second ostomy that leads to the remaining section of her ileum and her colon. This allows for Bennie’s colon to help absorb some more fluid and electrolytes.

Intestinal growth and adaptation

Because Bennie is premature, she still has time for her intestine to continue to grow more and also to adapt. We are hopeful to see gradual improvements in her absorption over the next few weeks as she grows.

So what does this look like for Bennie at home?

The current plan and idea is that Bennie will likely have another surgery to take down her two ostomies and reconnect her intestines before she comes home (this will be in ~8-10 weeks from now). She will likely come home getting some of her nutrition from breast milk and some from IV nutrition. As she gets older it is likely she will tolerate eating a variety of foods and she may not need IV nutrition long term.

Happy milestones:

Bennie is 3 weeks old (31 weeks GA)!

She is officially over 2 lbs!

She is stable on CPAP with minimal oxygen requirement!

She is tolerating small amounts of breast milk!

We started the re-feeding process into the colon!