Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Enteral nutrition · Indications · Formulations ·

Administration · Tube feeding

Key Messages

• Enteral nutrition (EN) should be provided to a pa-
  tient with a functioning gut whose energy and nu-
  trient requirements cannot be met by regular food
  intake via the normal oral route


• A standard age-appropriate isocaloric (1 kcal/1 ml)
  and iso-osmolar (300–350 mOsm/kg) polymeric en-
  teral formula is adequate and cost-effective for the
  majority of patients


• The stomach is the preferred delivery site, due to
  better tolerance and fewer complications. When
  long-term tube feeding (>6–12 weeks) is anticipat-
  ed, endoscopic stoma placement is the preferred
  method


• Close monitoring and strict adherence to estab-
  lished protocols are important as different compli-
  cations may occur


• EN can be stopped when oral intake satisfies nutri-
  tional requirements and growth continues to be
  age appropriate © 2015 S. Karger AG, Basel

Introduction

Enteral nutrition (EN) is defined as oral feeding
using special formulae, or delivery of food beyond
the esophagus via a feeding tube/stoma. In gen-

eral, it should be provided to a child with a suffi-

cient level of gastrointestinal function preserved

but who is unable to meet energy and nutrient

requirements by regular food intake via the nor-

mal oral route. It is also indicated whenever a liq-

uid diet is used for the treatment of a disease and

when the feeding time is excessively prolonged

(>4–6 h/day) [1]. Suggested criteria for nutrition-

al support are presented in table 1 [1, 2] , and spe-

cific clinical indications are listed in table 2. When

compared with parenteral feeding, EN has nu-

merous advantages, such as preservation of gas-

trointestinal function, lower costs, better man-

ageability and increased safety. However, in some

clinical settings such as intensive care units, reli-

ance on EN alone may result in severe underfeed-

ing despite a functional gut, mostly due to fluid

restriction, diagnostic procedures and inadequate

prescription and/or delivery [3]. In those patients

a combination of enteral and parenteral nutrition

is recommended [1]. There are only few absolute

contraindications to EN, such as necrotizing en-

terocolitis, intestinal perforation, gastrointestinal

obstruction and major intra-abdominal sepsis.

When the clinical condition of a patient is sta-

ble, home EN should be considered. Although a

dedicated team approach is required whenever

EN is provided [4] , its role is particularly impor-

tant in teaching parents and children techniques

required before being discharged, such as naso-

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

3.3 Enteral Nutritional Support

Sanja Kolaček