Clinical management of post-pyloric enteral feeding in children

Abstract

Post-pyloric feeding (PF) allows the administration of enteral nutrition beyond the pylorus, either into the duodenum or, ideally, into the jejunum. The main indications of PF are: upper gastrointestinal tract obstructions, pancreatic rest (e.g., acute pancreatitis), gastric dysmotility (e.g., critically ill patients and chronic intestinal pseudo-obstruction) or severe gastroesophageal reflux with risk of aspiration (e.g., neurological disability). Physiological and clinical evidence derives from adults, but can also be pertinent to children. This review will discuss the practical management and potential clinical applications of PF in pediatric patients. Some key studies pertaining to the physiological changes during PF will also be considered because they support the strategy of PF management.

Enteral Protein Supplementation in Critically Ill Children: A Randomized Controlled Pilot and Feasibility Study

“…However, this protocol might not reflect the practice of others centers. Although there is no consensus regarding the optimal site for EN, the gastric route is recommended because it is considered more physiological . Future trials will need to address the varying routes for protein supplementation and their tolerance.…”

“…Although there is no consensus regarding the optimal site for EN, the gastric route is recommended because it is considered more physiological. 10,37 Future trials will need to address the varying routes for protein supplementation and their tolerance. The use of parenteral protein (amino acid) supplementation must be considered in these trials, because it could improve eligibility and protein delivery, and might help enroll some of the sicker patients in the ICU.…”

The Use of Jejunal Tube Feeding in Children

“…There is no evidence indicating the exact rate of the EN delivery. Jejunal feeding should be provided continuously via volumetric enteral pump because bolus feeding or high infusion rate can cause diarrhoea, abdominal cramping, and dumping syndrome-like symptoms (99). Proposed increments are 1 to 5 mL/h every 24 hours for infants or 5 to 20 mL/h in older children every 4 hours until the target rate is reached (9,107).…”

Current Concepts in the Medical Management of the Pediatric Burn Patient

“…However, since some patients may require moderate sedation with ketamine for dressing changes and other minor procedures, a post-pyloric tube may be advantageous. With a post-pyloric feeding tube in place, the patient can continue to receive enteral nutrition prior to the procedure and also avoid additional exposure to general anesthesia [20]. Total parenteral nutrition is generally reserved for patients who cannot tolerate enteral feeds.…”