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Management Approach: Enteral Nutrition

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Failure to Thrive and Malnutrition

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Abstract

Nutritional and caloric requirements vary widely by age. As infants and children attain proper nutritional and caloric intake, most will grow following predictable patterns of progression in weight, length, and head circumference. When caloric intake is insufficient to maintain growth, a state of under-nutrition occurs (i.e. failure to thrive).

To obtain intake goals, pediatric fluids can be given via the enteral or parenteral route. Enteral nutrition, the feeding of nutritional products via the gastrointestinal tract, is generally considered the optimal form of nutrition attainment. Options include breast milk, formula, etc.; and specific subpopulations may best benefit from discrete formula types/modifications.

Unfortunately, various underlying conditions may necessitate parenteral nutrition, the giving of nutritional products intravenously. Parenteral nutrition guidelines are based on estimates of maintenance fluid needs, which can be calculated using the Holliday-Segar method (i.e. the 4-2-1 rule), or the Body Surface Area method.

While oral enteral delivery is standard, many circumstances exist in which this isn’t feasible or possible. In such circumstances, a feeding tube may be useful. Possible tubes include nasogastric, nasoduodenal, nasojejunal, or gastrostomy; and are selected via risk-benefit analyses.

Overall, nutritional enrichment or rehabilitation can be pursued through assorted means, and will be discussed in this chapter.

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References

  1. Hargrove JL. Does the history of food energy units suggest a solution to “Calorie confusion”? Nutr J. 2007;6:44. https://doi.org/10.1186/1475-2891-6-44.

    Article  Google Scholar 

  2. “calorie.” Merriam-Webster.com. 2011. https://www.merriam-webster.com (6 March 2022).

  3. Larson-Nath C, Biank VF. Clinical review of failure to thrive in pediatric patients. Pediatr Ann. 2016;45(2):e46–9. https://doi.org/10.3928/00904481-20160114-01.

    Article  Google Scholar 

  4. The National Academies of Sciences, Engineering, and Medicine. Summary report of the dietary reference intakes 1998.

    Google Scholar 

  5. Paul IM, Schaefer EW, Miller JR, et al. Weight change nomograms for the first month after birth. Pediatrics. 2016;138(6):e20162625. https://doi.org/10.1542/peds.2016-2625.

    Article  Google Scholar 

  6. Crossland DS, Richmond S, Hudson M, Smith K, Abu-Harb M. Weight change in the term baby in the first 2 weeks of life. Acta Paediatr. 2008;97(4):425–9. https://doi.org/10.1111/j.1651-2227.2008.00685.x.

    Article  CAS  Google Scholar 

  7. Wright CM, Parkinson KN. Postnatal weight loss in term infants: what is normal and do growth charts allow for it? Arch Dis Child Fetal Neonatal Ed. 2004;89(3):F254–7. https://doi.org/10.1136/adc.2003.026906.

    Article  CAS  Google Scholar 

  8. Macdonald PD, Ross SR, Grant L, Young D. Neonatal weight loss in breast and formula fed infants. Arch Dis Child Fetal Neonatal Ed. 2003;88(6):F472–6. https://doi.org/10.1136/fn.88.6.f472.

    Article  CAS  Google Scholar 

  9. Grummer-Strawn LM, Reinold C, Krebs NF. Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recomm Rep. 2010;59(Rr-9):1–15.

    Google Scholar 

  10. Zemel BS, Pipan M, Stallings VA, et al. Growth charts for children with down syndrome in the United States. Pediatrics. 2015;136(5):e1204–11. https://doi.org/10.1542/peds.2015-1652.

    Article  Google Scholar 

  11. Samour PQ, King K. Pediatric nutrition. 4th ed. Sudbury: Jones & Bartlett; 2011.

    Google Scholar 

  12. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R. 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005;41(Suppl 2):S1–87. https://doi.org/10.1097/01.mpg.0000181841.07090.f4.

    Article  Google Scholar 

  13. Miyasaka EA, Brown PI, Kadoura S, Harris MB, Teitelbaum DH. The adolescent child with short bowel syndrome: new onset of failure to thrive and need for increased nutritional supplementation. J Pediatr Surg. 2010;45(6):1280–6. https://doi.org/10.1016/j.jpedsurg.2010.02.100.

    Article  Google Scholar 

  14. Haliburton B, Mouzaki M, Chiang M, et al. Long-term nutritional morbidity for congenital diaphragmatic hernia survivors: failure to thrive extends well into childhood and adolescence. J Pediatr Surg. 2015;50(5):734–8. https://doi.org/10.1016/j.jpedsurg.2015.02.026.

    Article  Google Scholar 

  15. Prince A, Groh-Wargo S. Nutrition management for the promotion of growth in very low birth weight premature infants. Nutr Clin Pract. 2013;28(6):659–68. https://doi.org/10.1177/0884533613506752.

    Article  Google Scholar 

  16. Valentine CJ, Fernandez S, Rogers LK, et al. Early amino-acid administration improves preterm infant weight. J Perinatol. 2009;29(6):428–32. https://doi.org/10.1038/jp.2009.51.

    Article  CAS  Google Scholar 

  17. Lambe C, Poisson C, Talbotec C, Goulet O. Strategies to reduce catheter-related bloodstream infections in pediatric patients receiving home parenteral nutrition: the efficacy of taurolidine-citrate prophylactic-locking. JPEN J Parenter Enteral Nutr. 2018;42(6):1017–25. https://doi.org/10.1002/jpen.1043.

    Article  CAS  Google Scholar 

  18. Chesney CR. The maintenance need for water in parenteral fluid therapy, by Malcolm A. Holliday, MD, and William E. Segar, MD, Pediatrics, 1957;19:823–832. Pediatrics. 1998;102(1 Pt 2):229–30.

    Article  CAS  Google Scholar 

  19. Jasani B, Rao S, Patole S. Withholding feeds and transfusion-associated necrotizing enterocolitis in preterm infants: a systematic review. Adv Nutr. 2017;8(5):764–9. https://doi.org/10.3945/an.117.015818.

    Article  Google Scholar 

  20. Patel RM, Knezevic A, Shenvi N, et al. Association of red blood cell transfusion, anemia, and necrotizing enterocolitis in very low-birth-weight infants. JAMA. 2016;315(9):889–97. https://doi.org/10.1001/jama.2016.1204.

    Article  CAS  Google Scholar 

  21. Nützenadel W. Failure to thrive in childhood. Dtsch Arztebl Int. 2011;108(38):642–9. https://doi.org/10.3238/arztebl.2011.0642.

    Article  Google Scholar 

  22. Michałowska J. EER calculator—estimated energy requirement. https://www.omnicalculator.com/health/eer-estimated-energy-requirement

  23. Henry CJ. Basal metabolic rate studies in humans: measurement and development of new equations. Public Health Nutr. 2005;8(7A):1133–52. https://doi.org/10.1079/phn2005801.

    Article  CAS  Google Scholar 

  24. Carpenter A, Pencharz P, Mouzaki M. Accurate estimation of energy requirements of young patients. J Pediatr Gastroenterol Nutr. 2015;60(1):4–10. https://doi.org/10.1097/MPG.0000000000000572.

    Article  CAS  Google Scholar 

  25. Afzal NA, Addai S, Fagbemi A, Murch S, Thomson M, Heuschkel R. Refeeding syndrome with enteral nutrition in children: a case report, literature review and clinical guidelines. Clin Nutr. 2002;21(6):515–20. https://doi.org/10.1054/clnu.2002.0586.

    Article  CAS  Google Scholar 

  26. Stanga Z, Brunner A, Leuenberger M, et al. Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr. 2008;62(6):687–94. https://doi.org/10.1038/sj.ejcn.1602854.

    Article  CAS  Google Scholar 

  27. Gottrand F, Sullivan PB. Gastrostomy tube feeding: when to start, what to feed and how to stop. Eur J Clin Nutr. 2010;64(1):S17–21. https://doi.org/10.1038/ejcn.2010.43.

    Article  Google Scholar 

  28. Crawley-Coha T. A practical guide for the management of pediatric gastrostomy tubes based on 14 years of experience. J Wound Ostomy Continence Nurs. 2004;31(4):193–200. https://doi.org/10.1097/00152192-200407000-00007.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, NYU Grossman School of Medicine/Bellevue Hospital Center, New York, NY, USA

    Tiffany Williams

  2. Pediatric Hospital Medicine, AdventHealth for Children, Orlando, FL, USA

    Shani Cunningham

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  1. Tiffany Williams
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  2. Shani Cunningham
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Correspondence to Shani Cunningham .

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Editors and Affiliations

  1. Baylor College of Medicine/ Texas Children’s Hospital, Houston, TX, USA

    Joyee Goswami Vachani

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Williams, T., Cunningham, S. (2023). Management Approach: Enteral Nutrition. In: Vachani, J.G. (eds) Failure to Thrive and Malnutrition . Springer, Cham. https://doi.org/10.1007/978-3-031-14164-5_4

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  • DOI: https://doi.org/10.1007/978-3-031-14164-5_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14163-8

  • Online ISBN: 978-3-031-14164-5

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