ENTERAL BESLENME TEDAVİSİ UYGULANAN ÇOCUK HASTALARIN KLİNİK İZLEMİ

Abstract

Enteral nutrition (EN) is defined as the administration of nutritional support products orally or through a tube/stoma into the stomach or small intestine in patients who have a functional digestive system but cannot receive the amount of nutrients they should take daily. Enteral nutrition, which is an easy and reliable method of nutrition, is more physiological than parenteral nutrition. In this study, it was aimed to present the indications for EN, EN administration site, method, EN product characteristics, modification of these in time, clinical course in outpatient clinic follow-up, changes in anthropometric measurements and laboratory results in the course of treatment in patients who received nutritional support through feeding tube/stoma and to compare with the world literature. The data of 296 patients (137 females (46.3%), 159 males (53.7%), under the age of 18 years, who were followed up with tube and/or oral enteral nutrition for at least 6 months between 1 January 2018 and 1 January 2023 by the Department of Pediatric Gastroenterology, Hacettepe University Faculty of Medicine, were retrospectively analysed. The median age at EN initiation was 1.5 years. A diagnosis of neurological disease was present in 51.4% of the patients in whom EN was initiated. The most common indication for EN was inadequate and/or unsafe oral intake (n=256; 86.5%). The site of EN administration was distal pylorus in 1.4% (n=4/296) of tube/stoma fed patients and intragastric in 98.6% (n=292). Nasogastric tube feeding was given in 36.2%, nasojejunal tube feeding in 0.3%, and stoma feeding in 63.5% of the patients. Among the stomas, surgical gastrostomy + Nissen fundoplication was the most common method of nutrition (32.1%). The number of patients in whom enteral nutrition was administered only via tube/stoma and oral nutrition was not administered at all was 182 (61.5%). Bolus feeding was preferred by 88.9%, continuous infusion by 8.8%, and combined method by 2.4%. The most common indication for change in EN products was switching from infant enteral nutrition products to isocaloric/hypercaloric polymeric EN with increasing age. Hypercaloric infant products (n=114, 38.5%) were the most common EN products at baseline, followed by polymeric hypercaloric fibre products for >1 year (17.6%) and polymeric isocaloric fibre products for >1 year (15.2%). The number of patients who met their entire daily energy requirement from enteral nutrition products was 220 (74.3%) at baseline, 206 (69.6%) after the first EN product change and 192 (64.9%) after the second change. When patients with a stoma and tube-fed patients were compared in terms of calorie and protein intake from the EN product, energy and protein from the initial EN product were higher in tube-fed patients. The number of patients who developed nutritional intolerance while receiving enteral nutrition products was 74 (25%). The change in the median body weight (BW), height, body mass index (BMI) values and BW z score and BMI z score values of the patients over time (EN baseline, 6th month, 12th month and last examination) was statistically significant (p<0.001). No change was found in height z score. It was found that the increase in BMI z score was more prominent especially in the first 6 months, but the increase in BMI z score was statistically significant throughout the follow-up, although the rate decreased compared to the baseline. These data showed that tube/stoma feeding, whether or not accompanied by oral feeding, had a positive effect on VA z score and BMI z score, especially in the first 6 months, but had no effect on height z score. Therefore, it was thought that the effect of EB in acute malnutrition may be more noticeable.