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[Children on peritoneal dialysis and enteral feeding: indications and outcomes]
Insights
Children on peritoneal dialysis face growth retardation risks. Early enteral nutrition, particularly via gastrostomy, is crucial for improving growth outcomes in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Nutritional Science
Context:
- Children undergoing peritoneal dialysis (PD) are at high risk for growth retardation, especially with early-onset disease.
- Spontaneous nutrient intake is often insufficient, necessitating early enteral nutrition.
- Nutritional support is vital for improving quality of life and growth targets in these children.
Purpose:
- To highlight the critical need for early and intensive nutritional intervention in children on peritoneal dialysis.
- To compare the effectiveness of naso-gastric tubes versus gastrostomy for nutritional delivery in pediatric PD patients.
- To emphasize the importance of gastrostomy technique for optimizing growth parameters.
Summary:
- An intensive nutritional approach, initiated early, is essential for children on peritoneal dialysis to combat growth retardation.
- While both naso-gastric tubes and gastrostomy can deliver enteral nutrition, gastrostomy shows superiority in improving growth parameters.
- Despite intensive nutritional strategies, achieving adequate growth remains a challenge, suggesting undiscovered contributing factors.
Impact:
- This research underscores the importance of tailored nutritional strategies in pediatric nephrology.
- It advocates for the preferential use of gastrostomy over naso-gastric tubes for enhanced growth in children on PD.
- Further research is needed to identify all mechanisms influencing growth in this vulnerable population.
Abstract:
Despite improvements in overall prognosis, in the quality of life and in growth targets, children on peritoneal dialysis are subject to a high risk of growth retardation, especially if the disease begins in the early stages of life. In these patients, spontaneous feeding often does not provide an adequate intake of nutrients and early start of enteral nutrition needs to be considered. An intensive nutritional approach should always be established early and can be technically achieved using either a naso-gastric tube or a gastrostomy. In Italy, the first approach often involves the use of a naso-gastric tube despite epidemiological data suggesting the superiority of gastrostomy when the required outcome is improvement in growth parameters. Particular attention should be paid to the technique of gastrostomy. Despite this intensive approach, not all patients achieve the desired outcome of adequate growth probably because not all the possible mechanisms involved have yet been discovered.
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