Perspective on the paper by Barclay et al (see page 938)

Barclay and colleagues1 describe outcomes in children with intestinal failure (IF) referred to the specialist nutrition support team of a regional centre (Edinburgh) serving a population of 1.25 million. The patients concerned are principally those with short bowel syndrome (SBS) resulting from either congenital bowel disorders or necrotising enterocolitis (NEC) complicating prematurity. There are also a number with severe motility disorders and gastrointestinal mucosal disease.

Before adapting to full enteral feeding many similar patients will be dependent upon parenteral nutrition (PN) for months if not years; others will never become independent of PN. All are at risk from life-threatening complications including central venous catheter-related blood stream infection, intestinal failure-associated liver disease (IFALD) and venous thrombosis. While expert multidisciplinary care is known to decrease the risk of such problems, for an important minority of patients with IF, small bowel transplantation (SBT) offers the only hope of survival. Until recently SBT has been provided through a single UK centre (Birmingham Children’s Hospital, Birmingham), although a second unit (Kings College Hospital, London) is now developing. Such supra-regional units must also be able to undertake comprehensive clinical assessments and advise on management for a larger number of children with …