Enteral Nutrition in Paediatric

 Enteral Nutrition in  Paediatric  Enteral Nutrition in  Paediatric - Start

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EN in PAEDIATRICS . Lecture . objectives . Nutritional support in children . EN: Indications & contraindications . How to choose site & . route. Selection of formula. Complications . Nutritional Support in Sick Children . ID: 776577 Download Presentation

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Enteral Nutrition in Paediatric




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Presentations text content in Enteral Nutrition in Paediatric

Slide1

Slide2

Enteral Nutrition in

Paediatric

Slide3

EN in PAEDIATRICS Lecture objectives

Nutritional support in children

EN: Indications & contraindications

How to choose site &

route

Selection of formula

Complications

Slide4

Nutritional Support in Sick Children

GOALS

To provide energy & nutrients

to support:

 optimal growth

neuromotor

development

 minimize gastrointestinal symptoms

 promote normal feeding habits

& skills

To

treat a disease

(food allergy in infants,

Crohn’s

disease......)

Slide5

Nutritional Interventions in Sick Children Depend on:

Age

Clinical picture

Possibility of oral intake

Absorptive & digestive capacity

Dietary habits

Costs

Slide6

Slide7

Management strategy: nutritional counselling

Get

children eat more without unnecessary

restrictions

simplest

, cheapest &

safest nutritional support

Provide oral nutritional

supplement

-

whole protein based, pediatric formula,

nicely flavored

, with fibers

- energy enriched (1.3-1.5 kcal/ml) if more energy

required

Slide8

Enteral Nutrition

DEFINITION

Feeding

directly into stomach

or

duodenum / jejunum

over

tube or

stoma

Oral provision of dietary foods

for

special medical purposes

Slide9

EN vs. PN: Rule of Thumb

improves GUT

function

limits bacterial translocation & sepsis

decreases incidence of

multiorgan

failure

less

expensive

ENTERAL INTAKE

Use GUT whenever possible

&

as much as possible

Slide10

EN in Paediatrics W H E N??

Not

growing well on oral

intake

Not growing well ???

 Growth failure >1 months in child <2 y

 Growth failure >3 months in child >2 y

 Change on

centile

charts >2 growth channels

 Triceps

skinfolds

<5th percentile / age

EN

used as treatment of the disease (allergy,

Crohn

,

Total feeding time >4 h/day in disabled child

Slide11

EN: Clinical Indications

Slide12

EN: Contraindications

Necrotizing

enterocolitis

Intestinal perforation & obstruction

Major intra-abdominal

sepsis

Mechanical &

paralytical

ileus

Slide13

Selection of Formulae for EN

Slide14

Slide15

N6 FA

Immune system

Slide16

Slide17

Enteral Formula Selection

versus

unsupplemented

EN formula in:

a. patients and healthy controls

b.

predominant

symptom

diarrhoea

& constipation

Slide18

EN in CHILDREN: Sites for delivery

STOMACH

physiologic

antimicrobial effect

gradual

release

tubes easily placed

less

diarrhoea

, better osmotic

tolerance

JEJUNUM

in

patients with high risk of aspiration

gastric

outlet

obstruction

High energy and

hyperosmolar

???

Slide19

Nasoenteral Tubes

Nasoenteral

tubes

Nasogastric

Nasoduodenal

Nasojejunal

short-term nutritional supplementation

The tubes are typically made of flexible polyurethane or silicone with a diameter of 1.4 to 4.0 mm

Slide20

EN in CHILDREN: Sites for delivery

Silicon

PVC

Soft, flexible

Atraumatic

Expensive

Long duration (4-6 weeks)

Stiff, release

phalate

Traumatic Cheap

Short duration (4-6 d)

Slide21

Positioning of NG Tubes

Suggested by

acid pH (≤5) of the aspirate

epigastric

auscultation of injected air

correct external length of tube

If necessary check by

abdominal x-ray

no aspiration of gastric content

pH >5

patient’s condition suggests aspiration

Slide22

Positioning of the NG tubeMeasuring tube for children and infants and newborns

Slide23

Administration

bolus

feedings administered in 5 to 20 minutes

expensive than pump or gravity bolus feedings

A 60-mL syringe

3-4 time

Slide24

Intermittent Drip

allow mobile

patients more free time and autonomy compared with continuous

A schedule is based on 4-6 feedings per day

administered for 20 to 60 minutes.

Formula administration is initiated at 100 to 150

mL

per feeding

aspiration

Slide25

Continuous enteral feeding

Continuous drip infusion of formula requires a pump.

This

method is appropriate for patients who do not tolerate large-volume infusions

In SBS, after PN

surgery, cancer therapy, or other physiologic

(usually18 to 24 hours)

Slide26

PREVENTION & THERAPY

COMPLICATIONS Formula selection & delivery Osmolality, viscosity... Disease specific Gastrointestinal Diarrhoea, nausea, vomitting, Monitoring gastAspiration!! Tube, stoma selection & placement Endoscopy vs. surgery Technical Occlusion, migration, GIT lession Quality control & protocols hygieneInfectiveGastroenteritis, septicaemia Monitoring Growth (weight, height/length, skinfolds) Hematology, biochemistry Metabolic Fluid, glucose, electrolytes Trace elements, vitamins TEAM APPROACH!!! Psychological Oral aversion, altered taste Assess elec, ½ -2/3 requirmrnt(60kcaj/kg in 7y)Supp:1mm/kg Na, 4k, 0.6Mg, 1po4,B1 B2 B6 B9 trece elem.Refeeding syndrome(Mg, k,p) annemia ,weakness in child with AN, cancer,

Slide27

Disorders where enteral nut needed

SBS

Severe

diarrhoea

IBS

CF

Chronic liver Diseases

Abdominal

Slide28

EN in CHILDREN: routePEG / PEJ

Slide29

Management strategy: site & route

Slide30

EN Initiation

Gradual

increase in rate

and concentration

Depends on:

age

clinical condition

formula (

osmolality

!)

delivery route (jejunum !)

Slide31

Enteral Nutrition in Children

1.

Use

GUT whenever possible & as much as possible

2

. Standard polymeric formulas useful in >90% patients with best cost / benefit ratio

3

.

EN

is safe & effective method of

nutr

.

therap


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