title: Transpyloric enteral nutrition in the critically ill child with renal failure.
abstract: OBJECTIVE
  To study the efficacy and tolerance of transpyloric enteral nutrition (TEN) in the critically ill child with acute renal failure (ARF).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Paediatric intensive care unit.
  
  
  METHODS
  Critically ill children with ARF who received TEN were included in the study. They were compared with the remaining 473 critically ill children receiving TEN in this period. Tolerance of nutrition and gastrointestinal complications were assessed.
  
  
  METHODS
  Transpyloric enteral nutrition.
  
  
  RESULTS
  Fifty-three critically ill children with ARF aged between 3 days and 17 years received TEN. Children with ARF more frequently received parenteral nutrition before TEN (56.6%) than the other patients (17.5%). The incidence of shock, hepatic alterations and mortality was significantly higher in patients with ARF than in the remaining children. In children with ARF the mean duration of the TEN was 16.5-27.3 days and the maximum caloric intake was 77-26.7 kcal/kg/day. Thirteen patients (24.5%) presented gastrointestinal complications, 9 (17%) abdominal distension and/or excessive gastric residue, 5 (9.4%) diarrhoea, 1 necrotising enterocolitis and 1 duodenal perforation. The frequency of gastrointestinal complications was significantly higher in children with ARF. TEN was definitive suspended in five patients due to gastrointestinal complications. Four of these patients were treated with continuous renal replacement therapy. Thirty percent of patients died during TEN. In only one patient was the death related to complications of the nutrition.
  
  
  CONCLUSIONS
  Critically ill children with ARF tolerate TEN, although the incidence of gastrointestinal complications is higher than in other critically ill children.
authors.affiliation: Gregorio Marañón General University Hospital, Paediatric Intensive Care Unit, Dr Castelo 47, 28009 Madrid, Spain. pielvi@ya.com
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
authors.forename: César
authors.initials: C
authors.lastname: Sánchez
authors.forename: Angel
authors.initials: A
authors.lastname: Carrillo
authors.forename: Santiago
authors.initials: S
authors.lastname: Mencía
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Santiago
authors.forename: Amaya
authors.initials: A
authors.lastname: Bustinza
authors.forename: Dolores
authors.initials: D
authors.lastname: Vigil
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D011708:Pylorus; D017582:Renal Replacement Therapy; D016896:Treatment Outcome