Enteral nutrition is the preferredfeeding modality
Enteral nutrition is the preferredfeeding modality: Excerpt from Avoiding Common Pediatric Errors
Author:
Nailah Coleman, MD
What to Do - Make a Decision, Take Action
Nutritionprovidesadequate substrates, vitamins, minerals,andantioxidants
for cell and organ metabolism. The maintenance of adequate nutrition is
critical for preventing disease, and augmenting disease resolution. Unfortunately,therearetimesduringapatient'sdiseasecoursewhenenteralnutrition
cannot be used or is ineffective. At this time, parenteral nutrition may be
implemented to provide enough macro-and micronutrients to sustain life
and aid in disease recovery.
Multiple reviews and meta-analyses demonstrate the benefits of enteral
nutrition, when compared to parenteral nutrition. Patients receiving enteral
nutrition have decreased infectious and noninfectious complications. Their
cell-mediated immunity is improved and they experience less organ failure,
improved wound healing, and nitrogen balance. Active use of the intestinal
mucosa helps to preserve its integrity. With the early use of enteral nutrition, these patients have a reduced need for ventilatory support, decreased
intensive care unit (ICU) and hospital lengths of stay.
Enteralnutritionalsohascomplicationsassociatedwithitsuse.Mechanical complications are the most common. The feeding tube can become obstructed, inhibiting the flow of nutrition. Infection, at the site of tube entry is
apersistentrisk.Thepatientcanalsohavedifficultieswithelectrolytebalance
and adequate hydration. Patients receivingenteral nutrition may also experience gastroesophageal reflux, aspiration, refeeding syndrome, and diarrhea.
Despite these complications, enteral nutrition remains the nutritional
method of choice. An absolute contraindication to enteral nutrition is mechanical obstruction. Relative contraindications include a the gastrointestinal tract unable to be used or inadequate for absorption. Additionally,
clinicians may decide to use parenteral nutrition for convenience, ease of
delivery, and perceived patient comfort. Common diseases that often require parenteral nutrition include cerebral palsy, multiple sclerosis, Crohn
disease, congenital disorders, failure to thrive, and pancreatitis.
Once the decision is made to use parenteral nutrition, clinicians must
continually review the patient's nutrition, infectious, and immune status, because complications are common. Infectious complications occur frequently
and include catheter-related bloodstream infections and bacterial translocation of the nonfunctioning gut wall. In addition to becoming infected,
the patient's catheter may become occluded due to a thrombus, a kink, or a
precipitate. Patients may also exhibit metabolic disturbances, including elevatedbloodglucoselevelsandliverdisease—mainlysteatosis,steatohepatitis,
cholestasis, and cirrhosis, the latter two of which are more common in children. Immune compromise and metabolic bone disease have also been seen
in patients receiving parenteral nutrition. These complications contribute
to an increased hospital length of stay.
Maintaining patients' nutritional status is critical to their overall health
and to their disease process. The choice of enteral or parenteral nutrition
should be carefully considered, taking into account the indications, benefits,
and complications of both therapies. Parenteral nutrition is the preferred
methodtoprovidepatient'swithnecessarysubstratetomeetmetabolicneeds
during the course of illness and beyond.
Suggested Readings
DiBaise JK, Scolapio JS. Home parenteral and enteral nutrition. Gastroenterol Clin North Am.
2007:36:123–144.
Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit
Care Med. 2001;29:2264–2270.
Peter JV, Moran JL, Phillips-Hughes J. A meta-analysis of treatment outcomes of early enteral
versus early parenteral nutrition in hospitalized patients. Crit Care Med. 2005;33:213–220;
discussion 260–261.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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