Diamanti Antonella, Capriati Teresa, Mosca Antonella, Trovato Chiara Maria, Laureti Francesca, Mazzoli Bianca, Bolasco Giulia, Caldaro Tamara, De Peppo Francesco, Staccioli Susanna, Papa Raffaele Edo, Cerchiari Antonella, De Angelis Paola, Maggiore Giuseppe
Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
Unit of Palidoro Pediatric Surgery, Department of Specialized Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Front Nutr. 2023 Mar 22;10:1087603. doi: 10.3389/fnut.2023.1087603. eCollection 2023.
Recent decades have brought an increased survival of children with Neurologic Impairment (NI) but malnutrition and digestive comorbidity remain important challenges to face. We designed the present study to assess the course of nutritional status following standardized Home Enteral Nutrition (HEN) program and to evaluate impact of changing mode of feeding, as a part of overall multidisciplinary management, on digestive co-morbidity as Gastro-Esophageal Reflux Disease (GERD), Oropharyngeal Dysphagia (OPD), constipation and airway aspiration.
We performed a retrospective analysis on NI children entered into Institutional HEN program due to NI disorders between January 2011 and 2019. Demographic, anthropometric characteristics (BMI z-score and weight for age z-score) and symptoms (GERD, OPD constipation and airway aspiration) were collected at the enrolment and during the follow up.
We enrolled 402 patients (median age: 39 months); overall survival was 97%. Nutritional status was significantly improved by HEN; in particular growth profile significantly changed within the first 2 years following HEN beginning; GERD and airways aspirations decreased after HEN beginning. Constipation and OPD remained unchanged over time.
Malnutrition and digestive complaints are distinctive features of NI children. Nutritional status improve after 2 years from the beginning of standardized nutritional interventions. Overall multidisciplinary care, including standardized HEN protocols, seems to also impact on GERD and airway aspirations, which can decrease over time. It is possible that constipation and OPD, unchanged over time, are more dependent on underlying diseases than on overall treatments.
近几十年来，神经功能障碍（NI）患儿的生存率有所提高，但营养不良和消化系统合并症仍然是需要面对的重要挑战。我们设计了本研究，以评估标准化家庭肠内营养（HEN）计划后的营养状况进程，并评估作为多学科综合管理一部分的喂养方式改变对胃食管反流病（GERD）、口咽吞咽困难（OPD）、便秘和气道误吸等消化系统合并症的影响。
我们对2011年1月至2019年期间因NI疾病进入机构HEN计划的NI患儿进行了回顾性分析。在入组时和随访期间收集人口统计学、人体测量学特征（BMI z评分和年龄别体重z评分）以及症状（GERD、OPD、便秘和气道误吸）。
我们纳入了402例患者（中位年龄：39个月）；总体生存率为97%。HEN显著改善了营养状况；特别是在HEN开始后的头2年内，生长曲线有显著变化；HEN开始后GERD和气道误吸减少。便秘和OPD随时间保持不变。
营养不良和消化系统症状是NI患儿的显著特征。标准化营养干预开始2年后营养状况得到改善。包括标准化HEN方案在内的多学科综合护理似乎也对GERD和气道误吸有影响，随着时间推移这些情况可能会减少。便秘和OPD随时间保持不变，可能更多地取决于基础疾病而非整体治疗。
