title: Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition.
abstract: Enteral nutrition support (ENS) involves both the delivery of nutrients via feeding tubes and the provision of specialised oral nutritional supplements. ENS is indicated in a patient with at least a partially functioning digestive tract when oral intake is inadequate or intake of normal food is inappropriate to meet the patients' needs. The aim of this comment by the Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition is to provide a clinical practice guide to ENS, based on the available evidence and the clinical expertise of the authors. Statements and recommendations are presented, and future research needs highlighted, with a particular emphasis placed on a practical approach to ENS.Among the wide array of enteral formulations, standard polymeric feeds based on cow's-milk protein with fibre and age adapted for energy and nutrient content are suitable for most paediatric patients. Whenever possible, intragastric is preferred to postpyloric delivery of nutrients, and intermittent feeding is preferred to continuous feeding because it is more physiological. An anticipated duration of enteral nutrition (EN) exceeding 4 to 6 weeks is an indication for gastrostomy or enterostomy. Among the various gastrostomy techniques available, percutaneous endoscopic gastrostomy is currently the first option. In general, both patients and caregivers express satisfaction with this procedure, although it is associated with a number of well-recognised complications. We strongly recommend the development and application of procedural protocols that include scrupulous attention to hygiene, as well as regular monitoring by a multidisciplinary nutrition support team to minimise the risk of EN-associated complications.
authors.affiliation: University Children's Hospital, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Braegger
authors.forename: Tamas
authors.initials: T
authors.lastname: Decsi
authors.forename: Jorge Amil
authors.initials: JA
authors.lastname: Dias
authors.forename: Corina
authors.initials: C
authors.lastname: Hartman
authors.forename: Sanja
authors.initials: S
authors.lastname: Kolacek
authors.forename: Berthold
authors.initials: B
authors.lastname: Koletzko
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
authors.forename: Walter
authors.initials: W
authors.lastname: Mihatsch
authors.forename: Luis
authors.initials: L
authors.lastname: Moreno
authors.forename: John
authors.initials: J
authors.lastname: Puntis
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
authors.forename: Hania
authors.initials: H
authors.lastname: Szajewska
authors.forename: Dominique
authors.initials: D
authors.lastname: Turck
authors.forename: Johannes
authors.initials: J
authors.lastname: van Goudoever
mesh_terms: D002985:Clinical Protocols; D004750:Enteral Nutrition / Q000379:methods*; D005526:Food, Formulated; D005774:Gastrostomy; D006801:Humans; D017060:Patient Satisfaction; D010372:Pediatrics / Q000379:methods*