Transition to peptide‐based diet improved enteral nutrition tolerance and decreased healthcare utilization in pediatric home enteral nutrition

Abstract

Background: Home enteral nutrition (HEN) use continues to increase in children unable to meet nutritional needs through oral intake. Some patients do not tolerate standard polymeric formula (SPF), which may lead to malnutrition. Use of peptidebased diet (PBD) has demonstrated benefits in adults, however there remains a paucity of data in pediatric population. Methods: Retrospective review of medical records of children receiving HEN betweenOctober 2015 and October 2019 was conducted. Nutrition, tolerance, and healthcare utilization was tracked through May 2020. Children receiving PBD as initial formula or transitioned to PBD from SPF were included. Our objective was to assess gastrointestinal tolerance and impact on healthcare utilization in children receiving PBD.Results: During study period, 30 children (mean age, 9 ± 5.44 years; 20 of 30 [66.7%] male) utilized PBDs. Twenty-one patients started PBD directly with malnutrition as primary indication. Nine patients transitioned from SPF to PBD, most often due to intolerance of SPF (66%). After transition to PBD, no symptoms were reported in 6 of 9 (66.7%) patients, and symptoms of SPF intolerance resolved in 4 of 9 (44.5%) patients.Healthcare utilization declined significantly after transition to PBD, including mean numbers of emergency room visits (0.78 ± 1.09 to 0.11 ± 0.33; P = .025), provider visits

Peptide‐based formula: Clinical applications and benefits

“…Initiation of HEN with SPF remains the consensus recommendation of clinical nutrition therapy guidelines by ASPEN and ESPEN 5,12 . Due to this, the use of specialized formula in HEN is often considered when SPF intolerance occurs unless there is presence of complex underlying condition associated with severe malabsorptive disorder, at which time, PBF is used as the initial formula 29,35 . Several studies have evaluated the benefit of this approach 29,35 …”

“…14,36,37,53,[55][56][57] Additionally, a few retrospective reports have investigated the use of PBF in home settings as well. 29,35,38,51 Interestingly, the healthcare utilization and/or cost analysis and modeling of cost related to the use of PBFs suggest that transition to PBF in presence of EFI may principally be a cost-effective intervention. 29,35,52,54 Inpatient and critical care settings Early feeding for patients who are critically ill is crucial in reversing metabolic consequences of fasting and well as maintenance of GI functions.…”

“…29,35 Several studies have evaluated the benefit of this approach. 29,35 Mundi et al performed a retrospective review of adult HEN patients who utilized PBF either as initial formula or after EFI with SPF. 35 In patients who were started directly on PBF, around 50% did not report any EFI symptoms compared with only 20% of patients on SPF.…”

“…29,30 GI symptoms of EFI include nausea, vomiting, alteration of bowel movements, gastroesophageal reflux symptoms, and/or abdominal pain. 29 The high prevalence of EFI has always been a concern and is frequently raised in various clinical reviews. A recently presented retrospective analysis of prospectively maintained large HEN cohort noted that one in five patients receiving HEN (20.5%) developed at least one symptom of EFI symptoms interrupting their EN.…”

“…Another retrospective study reviewed EN tolerance in 754 hospitalized patients and noted that EFI was significantly prevalent among patients who were critically ill and were admitted to the ICU (36%) as well as in non‐ICU admissions (26%) 33 . In a retrospective analysis of nutrition outcomes in a relatively small HEN pediatric cohort, >50% of children reported at least one symptom of EFI 29 …”