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Transpyloric enteral nutrition in the critically ill child with renal failure

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Abstract

Objective

To study the efficacy and tolerance of transpyloric enteral nutrition (TEN) in the critically ill child with acute renal failure (ARF).

Design

Prospective observational study.

Setting

Paediatric intensive care unit.

Patients

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.

Intervention

Transpyloric enteral nutrition.

Measurements and 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.

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Acknowledgements

We are grateful to the nurses and doctors of the Paediatric Intensive Care Department for their collaboration in performing this study.

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Authors and Affiliations

  1. Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Dr Castelo 47, 28009, Madrid, Spain

    Jesús López-Herce, César Sánchez, Angel Carrillo, Santiago Mencía, Maria José Santiago & Amaya Bustinza

  2. Service of Preventive Medicine, Gregorio Marañón General University Hospital, Madrid, Spain

    Dolores Vigil

Authors
  1. Jesús López-Herce
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  2. César Sánchez
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  3. Angel Carrillo
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  4. Santiago Mencía
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  5. Maria José Santiago
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  6. Amaya Bustinza
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  7. Dolores Vigil
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Correspondence to Jesús López-Herce.

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López-Herce, J., Sánchez, C., Carrillo, A. et al. Transpyloric enteral nutrition in the critically ill child with renal failure. Intensive Care Med 32, 1599–1605 (2006). https://doi.org/10.1007/s00134-006-0271-x

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  • DOI: https://doi.org/10.1007/s00134-006-0271-x

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