The Use of Transpyloric Enteral Nutrition in the Critically Ill Child

Abstract

To assess the use and complications of transpyloric enteral nutrition (TEN) in the critically ill child we evaluated prospectively all children who received TEN in a pediatric intensive care unit (PICU) of a tertiary university hospital. The type of nutrition used, its duration, medication administered, tolerance, gastrointestinal complications (vomiting, abdominal distension or excessive gastric residue, diarrhea, and pulmonary aspiration), nongastrointestinal complications, and mortality were assessed. A comparative analysis was made between the first 2 years of the study and the remaining period. Over a period of 4.5 years, 152 patients between the ages of 3 days and 17 years received TEN for a duration of 19 ± 32.3 days (range 1–240 days). Forty‐one patients received TEN during the first 2 years; 100 patients received TEN in the postoperative period after cardiac surgery (66%). One hundred seventeen patients (77%) received sedation and 65 (43%) received muscle relaxants, presenting no extra complications. Twenty‐four patients (15.8%) presented with gastrointestinal complications: abdominal distension and/or excessive gastric residue in 17 and diarrhea in 11. Gastrointestinal intolerance was associated with pulmonary infection (p < 0.05), altered hepatic function (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). Diarrhea was more frequent in patients with shock (p < 0.05), altered hepatic function (p < 0.05), excessive gastric residue (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). In the second study period, the number of patients on TEN and the doses of sedatives, muscle relaxants, and vasoactives were higher (p < 0.05), with no increase in the incidence of complications. TEN is a useful method of nutrition with few complications in the critically ill child.

Postpyloric enteral nutrition in the critically ill child with shock: a prospective observational study

“…Enteral nutrition is safe and effective in most critically ill children [ 1 , 2 ]. The early initiation of enteral nutrition may preserve mechanical and immunological gut barrier function, stimulating intestinal trophism, and reducing bacterial translocation and the incidence of sepsis and multisystem failure [ 3 ].…”

Malnutrition in the Critically Ill Child: The Importance of Enteral Nutrition

“…However, numerous studies in the past decade have demonstrated that the majority of critically ill children tolerate enteral nutrition well [2,7,11,16,17,35]. Enteral nutrition is more physiological, has a trophic effect on the intestinal mucosa, and stimulates the intestinal immune system, decreasing bacterial overgrowth and translocation; it therefore reduces the incidence of sepsis and multiorgan failure.…”

“…Furthermore, enteral nutrition is associated with fewer hepatic and metabolic complications than parenteral nutrition, it is cheaper, it does not require special preparation, and it can be started and modified at any time. At the present time, although very few studies have compared the efficacy and complications of enteral and parenteral nutrition, and although enteral nutrition has not been shown to reduce mortality or length of PICU stay in comparison with parenteral nutrition, the majority of paediatric intensive care physicians consider that enteral nutrition should be the first method for feeding the critically ill child and that it should be started early [2,7,11,16,17,35–37]. …”