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

Background: Studies in adults have shown that transpyloric enteral nutritio n (TEN) is useful in certain patients who cannot tolerate oral or gastric f eeding. 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 inten sive 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 5 1 a combined regimen). The number of patients receiving PN and duration of PN declined significantly from 1993 (65 patients, 703 days) through 1996 (4 8 patients, 395 days). This was mirrored by the increase in the number of p atients 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 infect ion or mortality between the two groups. The cost of TEN was lower than tha t of PN, with an estimated annual saving of $5,422. Conclusions: Transpyloric enteral nutrition is a suitable method of nutriti onal support for critically ill pediatric patients. It has fewer complicati ons and a lower cost than PN.