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Transpyloric enteral feeding in critically ill children
E Panadero1, J López-Herce, L Caro
1Pediatric Intensive Care Section, Gregorio Marañón General University Hospital, Madrid, Spain.
Insights
Transpyloric enteral feeding (TEF) is a safe and effective nutritional support method for critically ill children. Complications are infrequent, and TEF can be used even with certain medications, reducing infection risks.
Area of Science:
- Pediatric critical care medicine
- Nutritional support strategies
- Gastroenterology in pediatrics
Background:
- Children have lower energy reserves and higher caloric needs due to growth.
- Effective nutritional support is crucial for critically ill children.
- Transpyloric enteral feeding (TEF) is a method for nutritional support in this population.
Purpose of the Study:
- To evaluate the utility and safety of transpyloric enteral feeding (TEF) in critically ill children.
- To assess the tolerance and complications associated with TEF.
- To determine the impact of TEF on pulmonary infection and hepatic dysfunction.
Main Methods:
- Prospective, descriptive study in a pediatric intensive care unit.
- 41 critically ill children (8 days to 12 years) received TEF via weighted feeding tubes.
- Analysis of tolerance and complications including vomiting, abdominal distension, gastric residual, diarrhea, and aspiration.
Main Results:
- TEF duration averaged 19.5 days; sedation or inotropic drugs did not affect tolerance.
- Gastrointestinal complications occurred in 10 patients (24%), most commonly abdominal distension and excessive gastric residual (17%).
- No pulmonary aspiration occurred; pulmonary infection and hepatic dysfunction incidence decreased during TEF.
Conclusions:
- Transpyloric enteral feeding is a viable nutritional support method for critically ill children.
- TEF can be safely administered to patients receiving neuromuscular blocking agents.
- The risks of pulmonary infection and hepatic dysfunction are low with TEF.
Background:
Nutrition is important in childhood because the child has a lower energy reserve than the adult and a higher demand for calories because of ongoing growth. In this study, the utility of transpyloric enteral feeding (TEF) in critically ill children was evaluated.
Methods:
A prospective, descriptive study was made in a pediatric intensive care unit of a tertiary pediatric center of 41 critically ill children, 30 after surgical procedures and 11 with nonsurgical illness, aged 8 days to 12 years, who received transpyloric enteral feeding with 8- or 10-Fr weighted feeding tubes. Analysis was made of tolerance and complications (vomiting, abdominal distension, excessive gastric residual, diarrhea, and pulmonary aspiration) of TEF.
Results:
The mean duration of TEF was 19.5 +/- 26.8 days (range, 1-120 days). The administration of sedative agents or inotropic drugs did not alter toleration of TEF. Eight of 12 patients treated with continuous infusion of vecuronium tolerated TEF without complications. Eleven gastrointestinal complications occurred in 10 patients, abdominal distension and excessive gastric residual in 7 (17%), and diarrhea in 4 (9.7%). In 7 patients gastrointestinal complications improved, with decreasing use or transitory interruption of TEF, but in 4 patients (9.7%), TEF had to be withdrawn. Gastrointestinal complications were more frequent in postsurgical than in nonsurgical patients (p < 0.001). No patients suffered from pulmonary aspiration, and the incidence of pulmonary infection and hepatic dysfunction diminished during TEF.
Conclusions:
Transpyloric enteral feeding is a good method of nutritional support in critically ill children and can be used in patients treated with neuromuscular blocking agents. The frequency and severity of complications and the risks of pulmonary infection and hepatic dysfunction related to TEF are low.