Pediatric Nutrition in Practice

154 Kolaček^

gastric (NG) tube placement and maintenance,
sterile feed preparation and administration, en-
teral pump management, as well as prevention,
recognition and management of the most com-
mon complications.
Transition to normal oral feed needs to be
gradual, and EN can be stopped when oral intake
satisfies caloric and nutrient requirements while
growth continues to be age appropriate.

Enteral Formula Properties and Selection
Criteria

Enteral formulae should supply a balanced intake
of energy and nutrients to support age-appropri-
ate growth and development. The content of all
essential nutrients should provide at least 100% of
the reference intake for healthy individuals of the
relevant age group. Standard (polymeric) pediat-
ric enteral formulae are recommended as the ad-
equate and cost-effective form of EN for the ma-
jority of patients [1] ; this implies an energy den-
sity of 1 kcal/ml (or 0.67 kcal/ml for infants),
iso-osmolality (300–350 mOsm/kg), whole pro-
teins as a nitrogen source, and a nutrient content
adapted to the requirements of children under the
age of 10 years. In addition, it is generally lactose
and gluten free. More concentrated enteral for-

mulae are also available (1.3–2.0 kcal/ml) for pa-

tients with increased energy requirements or lim-

ited fluid intake. Since recently, standard formu-

lations also contain nondigestible carbohydrates

(fibers), which have benefits in reducing gastroin-

testinal side effects such as diarrhea and constipa-

tion [5]. If pediatric formulae are not available, an

adult formulation can be used only after the age

of 8–10 years [1]. In polymeric formulae, macro-

nutrients are provided in an intact form. If pro-

teins are hydrolyzed to an extent that can be toler-

ated by at least 90% of patients with verified al-

lergy to the nitrogen source, the formula is called

‘semi-elemental’ or ‘oligomeric’ [6]. Monomeric/

elemental formulae are nutritionally complete so-

lutions containing amino acids, carbohydrates

and fats, often as a mixture of long- and medium-

chain triglycerides. A comparison of different

formulae is presented in table 3.

In contrast to standard EN formulae there are

disease-specific formulations which were first de-

veloped for infants and children with intolerances

such as food allergy or inborn errors of metabo-

lism and who required elimination of one or more

food components. The next step entailed different

modifications aiming to be beneficial against spe-

cific disorders. Examples are formulae with a high

fat content, which may be of value to patients with

insulin resistance and to hypercapnic patients

Ta b l e 3. Comparison of different enteral formulae for children and adults

Polymeric formulae Oligomeric formulae Monomeric formulae

Protein content, g/l 30 – 80 20 – 50 19.5 – 25
Nitrogen source polypeptides small peptides amino acids
Carbohydrate content, g/l 90 – 200 100 – 200 81 – 146
Fat content, g/l 20 – 90 5 – 20 35
Caloric density, kcal/ml 1 – 2 0.67 – 1.7 0.67 – 1
Osmolarity, mOsm/l 300 300 – 500 300 – 600
Advantages palatable, cheap hypoallergenic,
easily absorbed

nonallergenic

Disadvantages requires intact gut,
allergenic

bitter taste, expensive hyperosmolar,

expensive

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 152–157

DOI: 10.1159/000360330