O0080 ENTERAL VS. ORAL NUTRITIONAL SUPPORT IN INFANTS WITH PERSISTENT DIARRHEA SYNDROME AND MODERATE/SEVERE MALNUTRITION

Abstract

Introduction: Persistent diarrhea syndrome (PDS) is a multi-causal entity. In a high proportion of cases, primary and secondary malnutrition play an important role as an associated factor. Nutritional intervention is probably the most efficient way to interrupt the vicious circle of PDS/malnutrition. Our aim was to compare the efficacy of ad libitum oral and enteral nutritional support in infants with PSD and moderate or severe malnutrition. Methods: Design: Open clinical trial. Setting: A tertiary pediatric hospital, 2000–2002. Patients. n= 22, 12 (54.5%) boys. Inclusion: a) Consecutive infants with diarrhea associated to enteropathogenic bacteria or parasites and to secondary carbohydrate or protein intolerance lasting > 14 days, b) Z score of weigh for height <-2 SD. Exclusion: Patients with history of prematurity, glucose intolerance, short bowel syndrome, cystic fibrosis, autoimmune enterophaty, and primary lymphangiectasia. Sample size: Formula for clinical trials, a = 0.05, b = 80; n= 11 Nutritional intervention: A) Formula selection: Lactose intolerance: lactose-free formula; Glucose-polymer intolerance: glucose/chicken formula; Cow’s milk protein intolerance: soy formula; Cow’s milk & soy protein intolerance: protein hydrolyzed formula. B) Oral vs. enteral trial: 11 cases (50%) were managed with ad libitum PO formula; the other 8 cases were managed with a continuous infusion by a nasogastric tube (160–200 kcal/kg/day, 4–5g protein/kg/day). Outcome variables: Z score of height for age and weight for height on admission and on delivery. Statistics: Student t test (paired and for independent samples), Wilcoxon and Man-Whitney U tests. Results: PO group: no differences were observed in weigh/height z score on admission and after 22 days (−2.55 ± 0.5 vs. −2.42 ± 0.7, p > 0.05). EN group: admission and delivery weigh/height z score was–2.82 ± 0.6 and–1.70 ± 0.6 (p= 0.006). Serum albumin increased from 2.7 ±1.0 to 3.3 ± 0.5 in the EN group. Conclusion: Intragroup comparison of weight for height indexes showed no nutritional improvement in the ad libitum oral group while a significant nutritional improvement was observed in the enterally fed one. In the PO fed infants the weight for age on discharge was below 2SD while in the enterally fed infants it was above 2SD on discharge. The enteral feeding was the most useful option to obtain nutritional recovery in the infants reported with PDS and malnutrition.