CATCH-UP GROWTH IN CHILDREN WITH CHRONIC-RENAL-FAILURE TREATED WITH LONG-TERM ENTERAL NUTRITION

Growth retardation commonly complicates chronic renal failure in child ren. Although the etiology of this growth impairment is multifactorial , inadequate nutrition is considered an important cause in infants and young children. An ''aggressive'' nutritional approach has been repea tedly suggested in children with early onset chronic renal failure and poor feeding habits, but the possibility of inducing catch-up growth by energy supplementation is still controversial. The nutritional effe cts of a long-term, home-based enteral feeding program were studied in two infants and three children with moderate to severe chronic renal failure and impaired growth associated with persistent anorexia. In al l patients, renal failure had developed during the first year of life due to congenital diseases. Enteral feeding was performed at home, dur ing the night, through a silicone rubber nasogastric tube. The treatme nt lasted for 1 year. The energy intake ranged between 101% and 116% o f the recommended dietary allowance (RDA), and the protein intake betw een 96% and 113% of the RDA in all patients but one, in whom proteins were restricted to 75% of the RDA. All children showed a substantial i mprovement in deviation score for both weight (mean increase +1.76), h eight (mean increase +1.52) and in the general metabolic condition, ir respective of age, severity of osteodystrophy, or degree of renal fail ure. The treatment was well tolerated and, apart from a few episodes o f vomiting, no complications arose during the treatment. Tube feeding may be an effective therapeutic option for overcoming malnutrition whe n chronic renal failure is associated with persistent anorexia. In inf ants and young children, growth retardation can be opposed and catch-u p growth obtained.