Abstract
Background: There is limited information on therapeutic benefits and tube-related complications of pediatric nasoenteric (NE) tube feeding. We viewed, from different clinical aspects, NE tube feeding in children who are under intolerable conditions.Methods: A 10-years retrospective study enrolled 77 pediatric patients who underwent an endoscopic-guided placement of the NE tube for enteral nutrition. The evaluated data, including growth parameters, feeding volume, parenteral nutrition (PN) dependence, and nutritional markers [serum hemoglobin (Hb) and albumin] before and after NE tube feeding were compared. Tube-related complications and major adverse events were also recorded.Results: A total of 77 patients (including 50 males) underwent 176 endoscopic-guided placements of the NE tube with an average duration of 133.7 (6.0–1,847.3) days. The gastroesophageal reflux disease-related symptoms (vomiting, desaturations, and aspiration pneumonia) improved in 71.4% of patients. Feeding volume increased significantly after intervention, especially in patients with delayed gastric emptying, from 144.8 ± 28.5 to 1,103.1 ± 524.7 ml/days (p < 0.001). Weaning from PN was successfully achieved in 84.3% of patients with an average of 9.33 ± 7.30 days. About 16 patients (20.8%) were subsequently highly compatible with oral feeding after NE tube placement for an average of 24.7 ± 14.1 days. Patients either without neurologic dysfunction or with no ventilator-dependent status had a higher chance of shifting to oral feeding. Weight-for-age z-scores increased by 0.15 ± 1.33 after NE tube intervention. One NE tube-related adverse event, which caused bowel perforation at 6 days post-insertion, was recorded. No direct tube-related mortality was observed.Conclusions: Endoscopic-guided NE tube placement is a relatively safe, non-invasive procedure for pediatric patients who require enteral nutrition. Feeding via NE tube showed beneficial effects such as improvement in symptoms, PN weaning, and maintenance of body growth without major tube-related complications.
Highlights
Nutritional support is indicated for patients with inadequate nutrition intake or manifestation of wasting and stunting [1]
Children who were aged
Four indications used for NE tube placement are described as follows: (i) severe gastrointestinal reflux disease (GERD) with recurrent emesis despite prokinetic and antacid treatment, recurrent aspiration pneumonia, or frequent desaturation or bradycardia attack during or after feeding; (ii) delayed gastric emptying with gastric residuals of over 50% of the administered volume in the previous 4 h [8]; (iii) post-surgery nutritional support with a functioning gut but with complete intolerance to oral or NG tube feeding within the first postoperative week; and (iv) partial obstruction of the upper gastrointestinal tract (UGI) demonstrated by using barium study or direct endoscopic visualization
Summary
Nutritional support is indicated for patients with inadequate nutrition intake or manifestation of wasting and stunting [1]. Nasogastric (NG) tube is the most common and easiest route for pediatric patients to provide nutrition support [3]. In temporary or short-term situations, this method is most commonly performed via an NG tube into the stomach but can be achieved via post-pyloric access with a nasoenteric (NE) tube (nasoduodenal or nasojejunal tube) into the proximal small bowel [4]. Post-pyloric access is indicated in specific situations, such as severe gastrointestinal reflux disease (GERD) with a risk of aspiration, gastric emptying dysfunction, gastric outlet obstruction, acute pancreatitis, and previous gastric surgery precluding gastric feeding or in early postoperative feeding after major abdominal surgery [1, 5, 6]. From different clinical aspects, NE tube feeding in children who are under intolerable conditions
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