Transpyloric enteral nutrition in the critically ill child with renal failure.
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.
López-Herce
Jesús
J
Gregorio Marañón General University Hospital, Paediatric Intensive Care Unit, Dr Castelo 47, 28009 Madrid, Spain. pielvi@ya.com
Sánchez
César
C
Carrillo
Angel
A
Mencía
Santiago
S
Santiago
Maria José
MJ
Bustinza
Amaya
A
Vigil
Dolores
D
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