ABSTRACT
OBJECTIVES: Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimize its utility and safety. METHODS: A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations before placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long-term care, and ethical considerations were addressed.A systematic literature search was performed from 1982 to November 2018 using PubMed, the MEDLINE, and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.During a consensus meeting, all recommendations were discussed and finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors. RESULTS: A total of 33 recommendations were voted on using the nominal voting technique. CONCLUSIONS: JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team providing active follow-up and care.
Subject(s)
Enteral Nutrition , Gastrointestinal Diseases/therapy , Jejunum , Practice Guidelines as Topic , Child , Child Nutritional Physiological Phenomena , Europe , Humans , Jejunostomy , Nutritional Requirements , Societies, MedicalABSTRACT
AIM: Implementing international guidelines guarantees high standards of clinical care. A group of experts developed an algorithm to drive the management of common gastrointestinal symptoms in infancy by paediatricians and general practitioners. METHODS: The algorithm started from the evidence-based recommendations of the European Society of Gastroenterology, Hepatology and Nutrition and the European Society of Pediatric Infectious Diseases and an updated review of the literature. We used the structured quantitative method of nominal group technique to reach a consensus. RESULTS: A practical algorithm for the management of infants with acute diarrhoea was designed based on the consensus reached for each statement. The management of an infant with acute diarrhoea should include a sequence of actions: (i) a semiquantitative estimate of infant dehydration through validated clinical scores, (ii) rehydration therapy and early refeeding with breast milk or regular formula and (iii) effective agents to reduce the severity and duration of the diarrhoea. Finally, in children with prolonged diarrhoea, the search for aetiology should include persistent infections or reinfections, cows' milk protein allergy and coeliac diseases. Lactose should always be withdrawn. CONCLUSION: This algorithm provides an evidence-based sequence of interventions to optimise the management of infants with acute diarrhoea.
Subject(s)
Algorithms , Diarrhea/therapy , Acute Disease , Child, Preschool , Dehydration/diagnosis , Diarrhea/diagnosis , Fluid Therapy/methods , Humans , InfantABSTRACT
UNLABELLED: Up to 50% of infants present with symptoms of regurgitation, infantile colic and/or constipation during the first 12 months of life. Although they are often classed as functional disorders, there is an overlap with cows' milk allergy. We present practical algorithms for the management of such disorders, based on existing evidence and general consensus, with a particular focus on primary health care. Management consists of early recognition of warning signs of organic disease, parental reassurance and nutritional strategies. CONCLUSION: The proposed algorithms aim to help healthcare providers manage frequent gastrointestinal and cows' milk-related symptoms in infants safely and effectively.
Subject(s)
Colic/diagnosis , Constipation/diagnosis , Gastrointestinal Diseases/diagnosis , Milk Hypersensitivity/diagnosis , Algorithms , Colic/diet therapy , Constipation/diet therapy , Gastrointestinal Diseases/diet therapy , Humans , Infant , Milk Hypersensitivity/drug therapy , Parenting/psychologyABSTRACT
Gastro-oesophageal reflux (GOR) is a norma physiological process occurring daily in healthy infants with similar frequency in both breast- and bottle-fed infants. It is generally considered uncomplicated and self-limiting, resolving spontaneously by 12-14 months of age. In contrast, gastro-oesophageal reflux disease (GORD) is associated with more severe symptoms and, on occasions, oesophagitis. In the small percentage of cases that do not respond to simple feeding measures, a trial for 2-4 weeks using an extensively hydrolysed formula may be considered. Thickeners and antiregurgitation feeds may help with the frequency of overt regurgitation. Feeding difficulties can be a problem in infants with reflux, with some suffering extreme aversion to texture. In the small percentage of infants who experience faltering growth, high-calorie formulae can be used. In those with severe feeding difficulties or severe faltering growth, tube feeding may be required. Infants should ideally be managed within a multidisciplinary team including a speech and language therapist, psychologist, dietitian and paediatrician.
Subject(s)
Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Infant Care/methods , Child , Diagnosis, Differential , Enteral Nutrition , Gastroesophageal Reflux/etiology , Humans , Infant , Infant Food , Milk Hypersensitivity/diagnosis , Nursing Assessment , Parents/education , Parents/psychology , Patient Care Team , Pediatric Nursing/methods , Severity of Illness Index , Sudden Infant Death/epidemiology , Sudden Infant Death/etiology , Sudden Infant Death/prevention & controlABSTRACT
In most infants, GOR is a normal occurrence that is self-limiting and they will outgrow it. However, in those who experience more severe symptoms, a combination of medical and dietetic management under the care of a multidisciplinary team is important. Where feeding problems exist, input should include behavioural and psychological support.
