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Nasoduodenal feeding of the critically ill child
H P Leite1, W B de Carvalho, S Grandini
1Pediatric I.C.U., Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, Brasil.
Insights
Hospitalized children often suffer malnutrition, increasing illness and death risks. Enteral nutrition is superior to parenteral nutrition for maintaining gut health and function.
Area of Science:
- Clinical Nutrition
- Gastroenterology
- Pediatric Critical Care
Background:
- Malnutrition is common in hospitalized children, linked to higher morbidity and mortality.
- Critically ill patients can rapidly develop acute malnutrition due to hypercatabolism.
- Parenteral nutrition, while necessary, can lead to intestinal atrophy by depriving the gut of nutrients.
Purpose of the Study:
- To compare the effects of parenteral nutrition versus enteral feeding on intestinal function.
- To investigate the mechanisms behind intestinal mucosal changes during nutritional support.
Main Methods:
- Experimental studies in rats were used to compare intestinal mucosa response to parenteral nutrition versus enteral feeding.
- Measurements included mucosal weight, villus morphology, DNA and protein content, enzyme activity, and pancreatic function.
Main Results:
- Parenteral nutrition for 3 days led to intestinal mucosal hypoplasia in rats compared to enteral feeding.
- Specific changes included reduced mucosal weight and villus hypoplasia.
- Clinical studies showed these changes reversed upon reintroduction of digestive route feeding.
Conclusions:
- Enteral nutrition is a more physiological and safer route for nutritional support compared to parenteral nutrition.
- Intestinal atrophy during parenteral nutrition may be due to a lack of intraluminal amino acids for enzyme synthesis.
- Restoring enteral feeding can rapidly reverse negative intestinal changes.
Abstract:
Malnutrition frequently occurs among hospitalized children (19, 23, 24) and is associated with increased rates of morbidity and mortality (3, 5). Because of this hypercatabolic condition, a critically ill patient may undergo a process of acute malnutrition within a few days (7, 27, 34). The nutritional or metabolic support provided in these situations is usually by the parenteral or enteral route, depending on the presence of a functioning digestive tract. When exclusively parenteral feeding is used, prolonged fasting may deprive the intestine of specific nutrients and reduce its function of nutrient processing and absorption for lack of a substrate, with the consequent occurrence of atrophy. Clinical and experimental studies have demonstrated the advantages of the enteral route, which is more physiological, has a lower rate of complications and involves easier administration when compared to the parenteral route. Experimental studies (15, 21) have shown a hypoplastic response of the intestinal mucosa of rats after 3 days of parenteral nutrition when compared to controls submitted to enteral feeding. This response was measured in terms of mucosal weight, villus hypoplasia, DNA protein content, enzyme activity, and pancreatic function. Similar changes detected in clinical studies were rapidly reversed to normal after feeding by the digestive route (13). It is suggested that the mechanism of these alterations may involve the absence of intraluminal amino acids needed for enzyme synthesis rather than the lack of specific substrates inducing enzyme production.(ABSTRACT TRUNCATED AT 250 WORDS)