TRANSPYLORIC ENTERAL FEEDING IN CRITICALLY ILL CHILDREN

Background: Nutrition is important in childhood because the child has a lower energy reserve than the adult and a higher demand for calories because of ongoing growth. In this study, the utility of transpyloric enteral feeding (TEF) in critically ill children was evaluated. Metho ds: A prospective, descriptive study was made in a pe diatric intensiv e care unit of a tertiary pediatric center of 41 critically ill childr en, 30 after surgical procedures and 11 with nonsurgical illness, aged 8 days to 12 years, who received transpyloric enteral feeding with 8- or 10-Fr weighted feeding tubes. Analysis was made of tolerance and c omplications (vomiting, abdominal distension, excessive gastric residu al, diarrhea, and pulmonary aspiration) of TEF. Results: The mean dura tion of TEF was 19.5 +/- 26.8 days (range, 1-120 days). The administra tion of sedative agents or inotropic drugs did not alter toleration of TEF. Eight of 12 patients treated with continuous infusion of vecuron ium tolerated TEF without complications. Eleven gastrointestinal compl ications occurred in 10 patients, abdominal distension and excessive g astric residual in 7 (17%), and diarrhea in 4 (9.7%). In 7 patients ga strointestinal complications improved, with decreasing use or transito ry interruption of TEF, but in 4 patients (9.7%), TEF had to be withdr awn. Gastrointestinal complications were more frequent in postsurgical than in nonsurgical patients (p < 0.001). No patients suffered from p ulmonary aspiration, and the incidence of pulmonary infection and hepa tic dysfunction diminished during TEE Conclusions: Transpyloric entera l feeding is a good method of nutritional support in critically ill ch ildren and can be used in patients treated with neuromuscular blocking agents. The frequency and severity of complications and the risks of pulmonary infection and hepatic dysfunction related to TEF are low.