EN in PAEDIATRICS Lecture objectives Nutritional support in children EN Indications amp contraindications How to choose site amp route Selection of formula Complications Nutritional Support in Sick Children ID: 776577
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Slide1
Slide2Enteral Nutrition in
Paediatric
Slide3EN in PAEDIATRICS Lecture objectives
Nutritional support in children
EN: Indications & contraindications
How to choose site &
route
Selection of formula
Complications
Slide4Nutritional 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......)
Slide5Nutritional Interventions in Sick Children Depend on:
Age
Clinical picture
Possibility of oral intake
Absorptive & digestive capacity
Dietary habits
Costs
Slide6Slide7Management 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
Slide8Enteral Nutrition
DEFINITION
Feeding
directly into stomach
or
duodenum / jejunum
over
tube or
stoma
Oral provision of dietary foods
for
special medical purposes
Slide9EN 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
Slide10EN 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
Slide11EN: Clinical Indications
Slide12EN: Contraindications
Necrotizing
enterocolitis
Intestinal perforation & obstruction
Major intra-abdominal
sepsis
Mechanical &
paralytical
ileus
Slide13Selection of Formulae for EN
Slide14Slide15N6 FA
Immune system
Slide16Slide17Enteral Formula Selection
versus
unsupplemented
EN formula in:
a. patients and healthy controls
b.
predominant
symptom
diarrhoea
& constipation
Slide18EN 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
???
Slide19Nasoenteral 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
Slide20EN 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)
Slide21Positioning 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
Slide22Positioning of the NG tubeMeasuring tube for children and infants and newborns
Slide23Administration
bolus
feedings administered in 5 to 20 minutes
expensive than pump or gravity bolus feedings
A 60-mL syringe
3-4 time
Slide24Intermittent 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
Slide25Continuous 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)
Slide26PREVENTION & 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,
Slide27Disorders where enteral nut needed
SBS
Severe
diarrhoea
IBS
CF
Chronic liver Diseases
Abdominal
Slide28EN in CHILDREN: routePEG / PEJ
Slide29Management strategy: site & route
Slide30EN Initiation
Gradual
increase in rate
and concentration
Depends on:
age
clinical condition
formula (
osmolality
!)
delivery route (jejunum !)
Slide31Enteral 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