Pediatric Nutrition in Practice

186 Goulet^

eficial effect of EAABF was reported in an open
case study involving only 4 SBS patients with per-
sistent feeding intolerance [13]. A retrospective
study found a shorter duration of PN dependency
with the use of EAABF [14]. Current data are in-
sufficient to recommend such expensive formu-
las with often increased osmolality for infants
and children with SBS.

Glutamine (Gln) , a nonessential amino acid,

plays an important role in energy metabolism of

the intestinal mucosa and other rapid-turnover

tissues. A randomized controlled pilot study of

Gln-supplemented EF in infants with IF failed to

show any advantages [15]. Gln cannot be recom-

mende d u n le s s la rger mu lt ic enter t r ia l s on i n fa nt s

with IF provide evidence for beneficial effects.

Ta b l e 4. Different routes of feeding

Devices Indications Contraindications Advantages Disadvantages or risks

OF
None To be used
systematically

Artificial ventilation

Orofacial

malformation

Discontinuous physiologic

mode of feeding

Self-regulation of intake

EGF release by salivary

glands

Promotes bowel

adaptation

Psychological behavior

Insufficient intake

Gastric feeding
Nasogastric Nutritional support
<3 months

Severe GE reflux

Slow gastric emptying

Easy to place even at home Frequent dislodgements

Nasal symptoms

Percutaneous
endoscopic
gastrostomy

Nutritional support

>3 months

Repeated abdominal

surgery

Abnormal gastric

anatomy

Fewer occlusions with

larger bore, one-step low-

profile devices available

Skin injury at abdominal

exit site

Surgical
gastrostomy

Nutritional support

>3 months

Poor candidate for

surgery

Immediate placement of

low-profile device, direct

visualization of stomach

Open surgery

Duodenal or jejunal feeding
Nasojejunal Short term for
patients with severe
GERD, gastric
dysmotility

Recent proximal

surgical anastomosis

Radiologic or bedside

placement techniques

Noninvasive

Frequent dislodgements

Risk of intussusception

Nasal symptoms

Intestinal contamination

Gastrojejunal Longer-term EF for
patients with severe
GERD, gastric
dysmotility or need
for gastric
decompression

Recent proximal

surgical anastomosis

Endoscopic or radiologic

placement through

existing gastrostomy tube

Requires healing of

gastrostomy tract prior to

placement

Skin injury at abdominal

exit site

Frequent occlusions of

jejunal port

Intestinal contamination

Jejunal Long-term EF for
patients with severe
GERD and upper
intestinal dysmotility

Dysmotility Direct surgical access to

small intestine

Open surgical procedure

Mechanical problems

Intestinal contamination

GE = Gastroesophageal; GERD = gastroesophageal reflux disease.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 182–189

DOI: 10.1159/000360339