Enteral nutrition support (ENS) involves both the delivery of nutrients via feeding tubes and the provision of specialised oral nutritional supplements. ENS is indicated in a patient with at least a partially functioning digestive tract when oral intake is inadequate or intake of normal food is inappropriate to meet the patients' needs. The aim of this comment by the Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition is to provide a clinical practice guide to ENS, based on the available evidence and the clinical expertise of the authors. Statements and recommendations are presented, and future research needs highlighted, with a particular emphasis placed on a practical approach to ENS.
Among the wide array of enteral formulations, standard polymeric feeds based on cow's-milk protein with fibre and age adapted for energy and nutrient content are suitable for most paediatric patients. Whenever possible, intragastric is preferred to postpyloric delivery of nutrients, and intermittent feeding is preferred to continuous feeding because it is more physiological. An anticipated duration of enteral nutrition (EN) exceeding 4 to 6 weeks is an indication for gastrostomy or enterostomy. Among the various gastrostomy techniques available, percutaneous endoscopic gastrostomy is currently the first option. In general, both patients and caregivers express satisfaction with this procedure, although it is associated with a number of well-recognised complications. We strongly recommend the development and application of procedural protocols that include scrupulous attention to hygiene, as well as regular monitoring by a multidisciplinary nutrition support team to minimise the risk of EN-associated complications.
*University Children's Hospital, Zurich, Switzerland
†Department of Paediatrics, University of Pecs, Hungary
‡Hospital S. Joao, Porto, Portugal
§Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Israel
||University Children's Hospital Zagreb, Croatia
¶Dr von Haunersches Children's Hospital, University of Munich
#Department of Paediatrics, Deaconry Hospital, Schwaebisch Hall, Germany
**Escuela Universitaria de Ciencias de la Salud, Universidad de Zaragoza, Spain
††Leeds General Infirmary, United Kingdom
‡‡Medical University of Warsaw, Poland
§§Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, France
||||Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands.
4Representatives of the Committee on Gastroenterology.
Received 8 January, 2010
Accepted 8 January, 2010
Address correspondence and reprint requests to Sanja Kolaček, MD, Department of Paediatric Gastroenterology and Nutrition, University Children's Hospital Zagreb, 10000 Zagreb, Klaićeva 16, Croatia (e-mail: email@example.com).