ENTERAL VERSUS COMBINED ENTERAL AND PARTIAL PARENTERAL NUTRITION IN CRITICALLY ILL PEDIATRIC PATIENTS ON MECHANICAL VENTILATION

Abstract

Nutritional support of critically ill patients signifies the provision of nutrient substrates to patients during an interruption in the normal process of ingestion, absorption or utilization of foodstuffs < 6 l . The critically ill pediatric patient is particularly prone to the development of protein calorie malnutrition < 7 l . In general, the feeding techniques used for the critically ill patients, in order of frequency are : Total parenteral nutrition, combined enteral and parenteral, combined oral and parenteral, combined oral and enteral and oral feeding < 8 l.

The present work compared between enteral and combined enteral witl1 parenteral feedii1g in critically ill pediatric patients with respiratory failure on mechanical ventilation as regard its outcome and complications.

Tilis study was carried out on forty critically ill infants and children with acute respiratory failure admitted to Pediatric Intensive Care Unit, Tanta University Hospital where they were ventilated .

Assessment of the nutritional status of the infants and children was done at admission and weekly for three successive weeks by : History including the dietetic history, thorough clinical examination, anthropometric measurements as weight (% of ideal), triceps skinfold thickness, midarm circumference and midarm muscle circumference . Laboratory investigations were also done including: Serum albumin, transferrin concentration, total lymphocytic count and creatinine height index . From these assessment parameters and from tl1e method of nutritional support , patients were divided into four groups :The first was well nourished and enterally fed, the second was well nourished and combined enteral witl1 parenteral feeding, the third group was malnourished and enterally fed and the fourth group was malnourished and combined enteral with parenteral feeding .

All patients had nasogastric tube and central venous line through which a maintenance fluid was given till hemodynamic stability of the patients. Calculation of caloric requirements was done by Schofield equation, then enteral feeding with age appropriate formula was given to all patients according to gastrointestinal tract tolerance.