Transpyloric enteral nutrition reduces the complication rate and cost in the critically ill child.

BACKGROUND: Studies in adults have shown that transpyloric enteral nutrition (TEN) is useful in certain patients who cannot tolerate oral or gastric feeding. This study was conducted to compare TEN with parenteral nutrition (PN) in critically ill pediatric patients. METHODS: A retrospective descriptive study conducted in the pediatric intensive care unit of a tertiary pediatric referral center. All patients in the pediatric intensive care unit (PICU) receiving PN and/or TEN from January 1993 through December 1996 were included in the study. RESULTS: Two hundred forty patients (14.6% of all patients admitted to the PICU) received PN and/or TEN (168 exclusively PN, 21 exclusively TEN, and 51 a combined regimen). The number of patients receiving PN and duration of PN declined significantly from 1993 (65 patients, 703 days) through 1996 (48 patients, 395 days). This was mirrored by the increase in the number of patients receiving TEN and duration of TEN. The incidence of complications (hyperglycemia, hypertriglyceridemia, and cholestasis) was higher in the PN group. There was no difference in the incidence of hospital-acquired infection or mortality between the two groups. The cost of TEN was lower than that of PN, with an estimated annual saving of $5,422. CONCLUSIONS: Transpyloric enteral nutrition is a suitable method of nutritional support for critically ill pediatric patients. It has fewer complications and a lower cost than PN.

[Digestive tolerance for an enteral diet rich in fiber]. / Estudio de la tolerancia digestiva de una dieta enteral rica en fibra.

Study of 40 patients with no digestive pathology, 20 of whom were subjected to surgery of the larynx or maxillo-facial surgery, with regard to tolerance of an enteral diet with polysaccharides of soya which contribute 25 gr of dietetic fibre per 2,000 kilocalories, compared to that of an enteral diet poor in fibre and very often used due to good clinical tolerance. An increase in the frequency of bowel movement was observed, and in the quantity of motions, although there was no simultaneous change in number of motions per day, consistency or appearance of the faeces. Subjective tolerance to the diet was good, and patients felt less full and bloated than those on a diet which was poor in fibre. There were no significant differences between both diets with regard to nitrogen balance or plasmatic levels in the diet. The better tolerance of this diet with polysaccharides of soya leads us to recommend it, especially in patients with great needs with regard to energy or volume, provided that there are no malabsorption symptoms.