Enteral Nutrition Support in the Critically III Pediatric Patient

Nutrition for Children with Epidermolysis Bullosa

“…However, the potential effects of improved nutritional intake in chronic illness are wide ranging. 5 The subtle but positive influence of improved nutritional intake on the complex events surrounding immune status and attempted tissue repair are not fully understood, but it would seem reasonable to optimize intake if deficiency or imbalance is suspected. Table 1 describes the nutrition-related complications of different EB types and suggests appropriate interventions.…”

“…This phenomenon is thought to confer some advantage to the host; for example, sequestration and peripheral uptake of zinc and iron may ensure maximization of their availability for essential metabolic processes. 5 Nevertheless, certain parameters are generally monitored (see the article by Anna E. Martinez elsewhere in this issue for further exploration of this topic). Frequency of sampling depends on disease severity and the need to evaluate the impact of intervention, such as nutrient supplementation or introduction of an alternative feeding method, for example, gastrostomy placement.…”

“…The picture seen in other children who are critically sick is highly likely to be mirrored in severe EB, because the cascade of events mediated by cytokines and activation of the hypothalamic-pituitary-adrenal axis leads to catabolism and deranged physiology. 5 EB complications generally increase in number and intensity over time, and it is very difficult to judge whether growth and overall nutritional status are optimal. Although serial measurements of weight and height velocity are well-recognized means of evaluating adequacy of growth in sick and well children, comparison of the values of children with severe EB with age-and gender-matched healthy children's growth standards is of limited value.…”