Nutrition in the critically-ill Child. Past and Future.

1. Nutrition in the critically-ill Child. Past and Future. Dr. Rainer PaulinoBasulto. Msc Dra.MileidisPupo Vera. Dr. Willians Rios. I KatimaMulilo. Caprivi Health Directorate.

2. Abstract Enteral feeding is a commonly used form of nutritional supplementation for patients with intestinal failure, both in hospitals and in the community. This article concentrates on the basic principles of enteral feeding, including the physiological effects of feeding into the intestinal tract. It covers the indications for enteral feeding, the different methods of supplying enteral feeds to the gastrointestinal tract, and the potential complications.

3. INTRODUCTION Enteral nutrition consists of providing nutrients via the gastrointestinal tract. Although the term technically refers to nutrition given either by mouth or through a feeding tube, in common usage the term usually refers to tube feeding. In comparison to parenteral nutrition (the provision of nutrients via a venous catheter directly into the bloodstream), enteral nutrition offers several advantages, including lower costs, beneficial effects from utilization of the gastrointestinal tract, and avoidance of the many potential complications of parenteral nutrition.

4. Parental Nutrition Enteral nutrition The mucosal associated lymphoid tissues (MALT) are the specific arm of the immune system which protects the intestinal and extraintestinal external mucosal surfaces through production and secretion of IgA. MALT contains 50% of the body's total immune cell mass and produces more IgA than all other antibodies combined.

5. •Short enteral fasting (3 days), causes gut mucosal atrophy, expressed as a decrease in villus height and crypt depth Normal Atrophy. Intestinal Failure (stress). Bacterial Translocation. Mixed infection.

6. Provide humoral protection as a frontline defense against pathogen borne in aerosols, environment, and the diet. CD4

7. Hypothesis Critically ill children need enteral feeding for survival, so nutrition plays an important role on the health and development of a critically ill child.

8. Scientific problem

9. COST. Although enteral nutrition therapy is more costly than standard feeds, compared to parenteral nutrition therapy, enteral nutrition is approximately two- to fourfold cheaper on an inpatient or out-patient basis. Based on US Medicare charges, the annual cost of providing enteral nutrition per patient is approximately US$9,605 US$9,327 compared with US$55,193. US$30,596 for parenteral solu-tions.4 In addition, the frequency and cost of hospitalization is higher for patients supported on parenteral nutrition therapy compared with enteral nutrition therapy

10. Cheap

11. Objective. 1.To evaluate those factors that impact on the delivery of enteral tube feeding.

12. Method Bolus feeding(without pump) Bolus feeding involves the delivery of 10mls to 30mls over a period of 10-30minutes and can be given 4-6 times a day depending on patients individual feeding regime. Administration can be with a syringe using only the barrel as a funnel to allow the feed to infuse using gravity. Prospective studies With transversal curt. In 33 patient with Severe dehydration, Severe malnutrition, Severe Sepsis. Severe Malaria. prematurity

13. Result. Table 1 Age distribution

14. Result. Table 2.Distribution according to diagnosis

15. Table.3 Feeding Used.

16. Table. 4 Physiological effects of feeding into the intestinal tract

17. Table. 5 Physiological effects of feeding into the intestinal tract. Hemodynamic Parameter.

18. Table 6.Physiological effects of feeding into the intestinal tract. General condition.

19. Table 7. Physiological effects of feeding into the intestinal tract. Metabolic control.

20. Table 8. Physiological effects of feeding into the intestinal tract

21. Table 9.Physiological effects of feeding into the intestinal tract. Weigh behavior .

22. Table.10.Gastrointestinal complications in critically ill children with enteral tube nutrition

23. Table 11. Mortality rate.

24. Conclusions. Early enteral feedings are feasible, well tolerated, and cost effective in critically ill pediatric patients.

25. WHEN THE ENTERAL ROUTE IS AVAILABLE USE IT !

30. REFERENCES HarknessL. The history of enteral nutrition therapy: From raw eggs and nasal tubes to purified amino acids and early post-operative jejunal delivery. J Am Diet Assoc 2002;102:399–404. Braga M, Gianotti L, Gentilini O, et al. Early postopera-tive enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit Care Med 2001;29:242–8. de Lucas C, Moreno M, Lopez-Herce J, et al. Transpyloric enteral nutrition reduces the complication rate and cost in the critically ill child. J PediatrGastroenterolNutr 2000;30:175–80.

31. 4. Reddy P, Malone M. Cost and outcome analysis of home par-enteral and enteral nutrition. JPEN J Parenter Enteral Nutr 1998;22:302–10. 5. North American Home Parenteral and Enteral Nutrition Patient Registry. Annual report with outcome profi les 1985–1992. Albany, NY: Oley Foundation; 1994. 6. Howard L, Ament M, Fleming CR, et al. Current use and clinical outcome of home parenteral and enteral nutri-tion therapies in the United States. Gastroenterology 1995;109:355–65. 7. Board of Directors and Clinical Guidelines Task Force, American Society for Parenteral and Enteral Nutrition. Guidelines for the use of parenteral and enteral nutrition in adults and pediatric patients. JPEN J Parenter Enteral Nutr 2002;26:18SA–9SA. 8. Braunschweig CL, Levy P, Sheean PM, et al. Enteral com-pared with parenteral nutrition: A meta-analysis. Am J ClinNutr 2001;74:534–42