Pediatric Nutrition in Practice

156 Kolaček^

be combined, with tube feeding overnight for 10–
12 h and oral intake during the day.

Initiation of EN
Initiation of EN should be gradual, depending
on: (a) age; (b) clinical condition and gut status;
(c) formula choice (polymeric vs. elemental);
and (d) route of delivery (stomach vs. jejunum).
A slow, stepwise increase in volume and con-
centration is particularly important for patients
with grossly impaired intestinal function and
when the feed is delivered postpylorically.

Monitoring and Complications

Patients receiving EN should be monitored regu-
larly for growth, fluid, energy and nutrient intake,
therapeutic efficacy, and hematologic and bio-
chemical changes.
Possible complications and preventive mea-
sures are listed in table 4 [1]. Their occurrence
can be minimized by: (a) avoidance of drip feed-

ing and of blenderized feeds; (b) using silicon and

polyurethane NG tubes; (c) gradual initiation

and stepwise increase in volume and concentra-

tion; (d) regular monitoring of residual gastric

volumes; (e) strict adherence to management pro-

tocols, particularly with respect to bacteriologi-

cal safety; and (f) close supervision by a dedicated

multidisciplinary team [1, 4, 15].

Despite the broad range of potential complica-

tions, EN is a well-established, safe and effective

method of improving a patient’s clinical condi-

tion, nutritional status and growth, particularly

if procedural protocols are followed and regular

quality control is applied [1].

Areas for Future Developments and Research

• Defining the criteria for initiation of EN sup-
  port more precisely


• The suitability and benefits of disease-specific
  formulations should be evaluated in pediatric
  patients by controlled clinical studies

Ta b l e 4. Enteral feeding complications as well as preventive and therapeutic measures [1]

Complications Prevention and treatment

Gastrointestinal
Diarrhea, nausea, vomiting, bloating,
abdominal distension
Technical
Occlusion, migration
Metabolic
Fluid, glucose and electrolyte imbalance
Infective
Gastroenteritis, septicemia
Psychological
Oral aversion, altered body self-image

Formula selection

Polymeric vs. predigested

Disease specific

Feeding techniques

Bolus vs. continuous

Gradual initiation of EN

EN administration

Delivery site (stomach vs. jejunum)

Delivery route (tube vs. stoma)

Monitoring

Growth (weight, height/length, skinfolds)

Hematology, biochemistry

Multidisciplinary team approach

Protocol application and quality control

Others

Tube selection (PVC vs. silicon), maintenance

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