Endotoxemia following enteral refeeding in children

Area of Science:

• Pediatric Gastroenterology
• Immunology
• Critical Care Medicine

Background:

• Enteral feeding is crucial for gut health.
• Prolonged fasting can alter gastrointestinal function.
• The impact of reintroducing enteral nutrition after deprivation is not fully understood.

Purpose of the Study:

• To investigate the physiological response to enteral feeding after a period of deprivation in children.
• To assess for transient endotoxemia and its correlation with inflammatory markers and liver function.

Main Methods:

• Measured plasma endotoxin-like activity, tumor necrosis factor alpha (TNFalpha) concentrations, core body temperature, and liver function tests.
• Evaluated these parameters before and after initiating enteral feeding in children previously deprived of nutrition for 5 days.

Main Results:

• Transient endotoxemia and elevated plasma TNFalpha concentrations were observed post-enteral feeding.
• Core body temperature and liver function tests (AST, ALT, bilirubin) remained within normal limits despite endotoxemia.
• The observed endotoxemia was attributed to enteral feeding following deprivation, not an immature gastrointestinal tract.

Conclusions:

• Reintroducing enteral feeding after a 5-day deprivation can lead to transient endotoxemia in children.
• This transient endotoxemia appears to be a physiological response to increased mesenteric circulation and peristalsis.
• No adverse clinical consequences were observed, suggesting the pediatric gut can tolerate this transient endotoxemia.