Nutritional management of neonates who undergo major surgery for gastrointestinal disorders: a joint position paper of the Italian Society of Neonatology (SIN), the Italian Society of Pediatric Surgery (SICP), and the Italian Society of Pediatric Nutrition (SINUPE).

Neonates undergoing major gastrointestinal surgery for congenital or acquired disorders require complex nutritional management to support their growth and recovery. Prolonged fasting can be detrimental, necessitating timely and appropriate nutritional support. This joint position paper by the Italian Society of Neonatology, the Italian Society of Pediatric Surgery, and the Italian Society of Pediatric Nutrition aims to provide evidence-based suggestions for the nutritional care of these vulnerable infants, addressing the lack of robust randomized controlled trials in this field through expert opinion. A panel of experts in neonatology, paediatric surgery, and paediatric nutrition across Italy reviewed the literature by searching the PubMed database (1990- September 2024) using specific keywords. English-language papers were analysed without restrictions on study design or outcomes. Identified references were cross-checked, and additional relevant literature was included based on expert knowledge. The panel formulated suggestions based on the available evidence and clinical expertise. The position paper provides specific suggestions for various aspects of nutritional management, including the timing and modalities of enteral nutrition (EN), the choice of milk (prioritizing human milk), vitamin and trace element supplementation, and condition-specific guidance for gastrointestinal disorders such as oesophageal atresia, congenital diaphragmatic hernia, chylothorax, intestinal atresia, abdominal wall defects, Hirschsprung disease, necrotizing enterocolitis, and intestinal failure. Early EN (within 48 hours post-surgery) is generally advised and then tailored according to feeding tolerance. The paper also emphasizes the importance of monitoring micronutrient deficiencies and promoting oral feeding skills. This joint position paper offers a comprehensive and multidisciplinary approach to the nutritional management of neonates undergoing major gastrointestinal surgery. Recognizing the limitations of current evidence, these suggestions aim to standardise and optimise nutritional care, based on available data and expert consensus, ultimately improving outcomes for this high-risk population. The paper highlights the need for individualised nutritional strategies, careful monitoring, and further research in this challenging area of neonatal care.