Practice guidelines. High-output stomas in pediatrics: pathophysiology, clinical consequences and recommendations for metabolic and nutritional support

Abstract

Introduction: high-output stomas represent a significant cause of morbidity in pediatric patients with intestinal failure, commonly leading to dehydration, fluid and electrolyte imbalances, and nutritional deterioration. Despite their substantial clinical impact, management in children relies largely on the extrapolation of evidence derived from adult populations.
Objectives: to review the available evidence regarding high-output stomas in pediatrics and propose a practical, stepwise clinical approach based on underlying pathophysiology and geared toward multidisciplinary care.
Methodology: a narrative review of the pediatric and adult literature was conducted, covering high-output stomas, intestinal failure, fluid and electrolyte management, nutritional support, pharmacological therapies, and adjuvant strategies such as chyme reinfusion.
Discussion: there are no comparative studies or controlled trials specifically evaluating the management of high-output stomas in children. The clinical approach relies on optimizing fluid and electrolyte management, providing individualized nutritional support, and utilizing stepwise pharmacological therapy in selected cases. Chyme reinfusion emerges as a potentially beneficial strategy in select pediatric patients, particularly during the neonatal period, although current evidence remains limited.
Conclusions: in the absence of specific pediatric evidence, the management of high-output stomas must be grounded in a systematic, multidisciplinary, and pathophysiologically sound approach. Early identification of at-risk patients and close monitoring are crucial to minimizing complications and improving clinical outcomes. Prospective pediatric studies are required to establish evidence-based clinical practice guidelines.