Axelrod David, Kazmerski Kimberly, Iyer Kishore
Intestinal Rehabilitation and Transplantation Program, Division of Transplant Surgery, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
JPEN J Parenter Enteral Nutr. 2006 Jan-Feb;30(1 Suppl):S21-6. doi: 10.1177/01486071060300S1S21.
Common to all pediatric patients receiving enteral nutrition is the inability to consume calories orally. This is often secondary to issues of inadequate weight gain, inadequate growth, prolonged feeding times, weight loss, a decrease in weight/age or weight/height ratios, or a persistent triceps skinfold thickness <5% for age. Enteral nutrition requires enteral access. In the neonatal period the nasoenteric route is usually used. In pediatric patients requiring long-term enteral access, surgically, endoscopically, or radiologically placed percutaneous feeding tubes are common. Jejunal feeding tubes are used in pediatric patients with gastric feeding intolerance or persistent gastroesophageal reflux. Low-profile enteral access devices are preferred by most pediatric patients because of their cosmetic appearance. For most children, a standard pediatric polypeptide enteral formula is well tolerated. There are specialized pediatric enteral formulas available for patients with decreased intestinal length, altered intestinal absorptive capacity, or altered pancreatic function. Weaning patients from tube feeding to oral nutrition is the ultimate nutrition goal. A multidisciplinary approach to patients with short bowel syndrome will maximize the use of enteral nutrition while preserving parenteral nutrition for patients with true enteral nutrition therapy failure.
所有接受肠内营养的儿科患者的共同特点是无法经口摄入热量。这通常继发于体重增加不足、生长发育不良、喂养时间延长、体重减轻、体重/年龄或体重/身高比下降，或肱三头肌皮褶厚度持续低于同龄人5%等问题。肠内营养需要建立肠内通路。在新生儿期通常采用鼻肠途径。对于需要长期肠内通路的儿科患者，通过手术、内镜或放射学方法放置经皮饲管很常见。空肠饲管用于有胃喂养不耐受或持续性胃食管反流的儿科患者。大多数儿科患者更喜欢使用外形美观的低轮廓肠内通路装置。对于大多数儿童来说，标准的儿科多肽肠内配方耐受性良好。对于肠长度减少、肠道吸收能力改变或胰腺功能改变的患者，有专门的儿科肠内配方可供使用。使患者从管饲过渡到口服营养是最终的营养目标。对短肠综合征患者采用多学科方法，将最大限度地利用肠内营养，同时为真正的肠内营养治疗失败的患者保留肠外营养。
