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Enteral Nutrition
Highlights
The Nutritional Challenges in a patient with Chronic Pancreatitis
Introduction/overview Chronic pancreatitis is a progressive and irreversible inflammatory disease of the pancreas. This results in exocrine and endocrine dysfunction which in time leads to maldigestion and malabsorption reducing the body’s ability to utilise essential macro and micronutrients. Consequently protein energy malnutrition is common. Research indicates that in more than 80...
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The prevalence of children with complex neuro-disability has increased due to advances in the medical management of preterm infants and improved care for children with severe neurological impairment . Neuro-disability covers a wide range of clinical conditions, including acquired brain injury, epilepsy and learning disability. Neuro-disabilities present a significant disease burden for the child and family, with the focus for families to promote the best possible participation in life for all affected.Children with neuro-disabilities can be significantly disadvantaged in their ability to nourish themselves due to poor hand to mouth motor coordination, along with disordered swallowing, resulting in aspiration of food in the lungs. The length of feeding time may be considerably increased and instead of mealtimes being an enjoyable experience, they are distressing for both child and carer. These impairments in feeding eventually lead to undernutrition and invariably children require a feeding tube to ensure nutritional requirements are met. Although tube feeding improves overall nutritional status, it has also been associated with an excess deposition of body fat compared with typically developing children. Children with neuro-disability are at risk of becoming overweight because of their low activity and psychosocial constraints. Additionally, children with a neuro-disability tend to grow slowly for non-nutritional reasons and have altered body composition due to underdeveloped skeletal muscle. Children are more likely to be overweight and tend to have low lean muscle mass - therefore a low BMI in this group does not necessarily imply low fat stores. Efforts are needed to protect severely disabled children from overfeeding and to help families of children with neuro-disabilities to manage their child’s weight.Children with neuro-disabilities who are fed to 80% of their estimated average energy requirements have reported a positive energy balance resulting in high body fat mass. Of note, any attempt to dilute the existing proprietary feeds to reduce the calorie intake to a level commensurate with the energy expenditure of a child with a disability is likely to have an adverse impact on micronutrient and protein intake.The clinical nutrition industry has responded to this need and developed commercially available enteral formulas that are low in energy but nutritionally adequate for protein and micronutrients, essential for developing children who are reliant on enteral formula to supply a major proportion of their intake [8]. Additionally, feed tolerance is generally worse in children with neuro-disabilities, associated with comorbidities including epilepsy, posture and tone disorders, and medications used for the treatment of these conditions can further exacerbate gastrointestinal function. Common feed related symptoms associated with neuro-disabilities include vomiting, retching, pain associated with feeding - feedinduced dystonia, constipation, and gastrointestinal dysmotility.The aim of this national multicentre retrospective study was to monitor the effectiveness of a low energy hydrolysed enteral formula on weight management, feed tolerance and health economics in children with a neuro-disability.
This case study discusses the nutritional management of a severely undernourished patient with head and neck cancer. The patient experienced diarrhoea and significant weight loss, despite the use of various enteral formulas and delivery methods (continuous and bolus feeding). Thereafter a combination of products within the Peptamen® range were trialled. A marked reduction i...
Recently, as reported by dietetic departments in the United Kingdom, we have seen an increase in Homemade Blended Diets (HBD) being given to children requiring tube feeding. HBD practice may increase the risk of tube occlusion and nutritional inadequacies. In 2015 the British Dietetic Association (BDA) developed their first ‘Practice toolkit liquidised food via gastrostomy tube’, whic...
Many patients requiring long term enteral nutrition have neurological disorders, such as motor neurone disease (MND) or Huntington’s disease (HD). In our experience, a proportion of these individuals may struggle to tolerate enteral feeding despite optimising medical management and excluding obvious gastrointestinal pathology. In MND, prolonged reduced mobility, weaknes...
Major trauma refers to significant or multiple injuries that could result in death or severe disability, sustained from a traumatic insult such as a road traffic collision, fall, sporting accident, or physical assault. It is the leading cause of death and major disability in people aged under 45 years in the UK.1 Critically injured patients are often managed on ...
Videos
This real-world evidence study explores the results from a UK multi-centre retrospective study of children who have switched to a tube feed containing food-derived ingredients. Read the publication, or watch our webinar where speakers discuss the positive outcomes and the potential impact they might have on local guidelines or day to day clinical practice.
Learn more about MCTs and their role in reducing fat malabsorption
We have seen increasing interest in using blenderized real food for enteral nutrition. How is the trend evolving, what is the impact on pediatric patients, and should it be supported by healthcare professionals?
This webinar dives into the emerging trend of blended diets for enteral feeding. There is some evidence to suggest that blended diets, used solely or in combination with commercially available enteral feeds, can have a number of benefits for children such as a reduction in GI symptoms or improved overall physical and developmental health.
Barbara Davidson, Specialist Dietitian from the Freeman Hospital discusses the nutritional challenges of managing acute patients with pancreatitis.
Due to reduced levels of physical activity in children with cerebral palsy or other neurodisabilities, there is a risk of tube-fed individuals becoming overweight or obese if their feed contains an excess of calories. Nestlé Health Science provide a nutritionally complete, lower energy formula, Peptamen® Junior 0.6, that can be used to overcome this problem. Peptamen® Junior 0.6 is a well tolerated, low-energy, peptide-based feed with fibre that has been shown to reduce gastrointestinal symptoms in children with neurological impairment. Food for special medical purposes. Enteral tube feed for the dietary management of patients with or at risk of malnutrition. Must be used under medical supervision.
This real-world evidence study explores the results from a UK multi-centre retrospective study of children who have switched to a tube feed containing food-derived ingredients. Read the publication, or watch our webinar where speakers discuss the positive outcomes and the potential impact they might have on local guidelines or day to day clinical practice.
Learn more about MCTs and their role in reducing fat malabsorption
We have seen increasing interest in using blenderized real food for enteral nutrition. How is the trend evolving, what is the impact on pediatric patients, and should it be supported by healthcare professionals?
This webinar dives into the emerging trend of blended diets for enteral feeding. There is some evidence to suggest that blended diets, used solely or in combination with commercially available enteral feeds, can have a number of benefits for children such as a reduction in GI symptoms or improved overall physical and developmental health.
Barbara Davidson, Specialist Dietitian from the Freeman Hospital discusses the nutritional challenges of managing acute patients with pancreatitis.
Due to reduced levels of physical activity in children with cerebral palsy or other neurodisabilities, there is a risk of tube-fed individuals becoming overweight or obese if their feed contains an excess of calories. Nestlé Health Science provide a nutritionally complete, lower energy formula, Peptamen® Junior 0.6, that can be used to overcome this problem. Peptamen® Junior 0.6 is a well tolerated, low-energy, peptide-based feed with fibre that has been shown to reduce gastrointestinal symptoms in children with neurological impairment. Food for special medical purposes. Enteral tube feed for the dietary management of patients with or at risk of malnutrition. Must be used under medical supervision.
Major trauma refers to significant or multiple injuries that could result in death or severe disability, sustained from a traumatic insult such as a road traffic collision, fall, sporting accident, or physical assault. It is the leading cause of death and major disability in people aged under 45 years in the UK.1 Critically injured patients are often managed on ...
This case study discusses the nutritional management of a severely undernourished patient with head and neck cancer. The patient experienced diarrhoea and significant weight loss, despite the use of various enteral formulas and delivery methods (continuous and bolus feeding). Thereafter a combination of products within the Peptamen® range were trialled. A marked reduction i...
The prevalence of children with complex neuro-disability has increased due to advances in the medical management of preterm infants and improved care for children with severe neurological impairment . Neuro-disability covers a wide range of clinical conditions, including acquired brain injury, epilepsy and learning disability. Neuro-disabilities present a significant disease burden for the child and family, with the focus for families to promote the best possible participation in life for all affected.Children with neuro-disabilities can be significantly disadvantaged in their ability to nourish themselves due to poor hand to mouth motor coordination, along with disordered swallowing, resulting in aspiration of food in the lungs. The length of feeding time may be considerably increased and instead of mealtimes being an enjoyable experience, they are distressing for both child and carer. These impairments in feeding eventually lead to undernutrition and invariably children require a feeding tube to ensure nutritional requirements are met. Although tube feeding improves overall nutritional status, it has also been associated with an excess deposition of body fat compared with typically developing children. Children with neuro-disability are at risk of becoming overweight because of their low activity and psychosocial constraints. Additionally, children with a neuro-disability tend to grow slowly for non-nutritional reasons and have altered body composition due to underdeveloped skeletal muscle. Children are more likely to be overweight and tend to have low lean muscle mass - therefore a low BMI in this group does not necessarily imply low fat stores. Efforts are needed to protect severely disabled children from overfeeding and to help families of children with neuro-disabilities to manage their child’s weight.Children with neuro-disabilities who are fed to 80% of their estimated average energy requirements have reported a positive energy balance resulting in high body fat mass. Of note, any attempt to dilute the existing proprietary feeds to reduce the calorie intake to a level commensurate with the energy expenditure of a child with a disability is likely to have an adverse impact on micronutrient and protein intake.The clinical nutrition industry has responded to this need and developed commercially available enteral formulas that are low in energy but nutritionally adequate for protein and micronutrients, essential for developing children who are reliant on enteral formula to supply a major proportion of their intake [8]. Additionally, feed tolerance is generally worse in children with neuro-disabilities, associated with comorbidities including epilepsy, posture and tone disorders, and medications used for the treatment of these conditions can further exacerbate gastrointestinal function. Common feed related symptoms associated with neuro-disabilities include vomiting, retching, pain associated with feeding - feedinduced dystonia, constipation, and gastrointestinal dysmotility.The aim of this national multicentre retrospective study was to monitor the effectiveness of a low energy hydrolysed enteral formula on weight management, feed tolerance and health economics in children with a neuro-disability.
Introduction/overview Chronic pancreatitis is a progressive and irreversible inflammatory disease of the pancreas. This results in exocrine and endocrine dysfunction which in time leads to maldigestion and malabsorption reducing the body’s ability to utilise essential macro and micronutrients. Consequently protein energy malnutrition is common. Research indicates that in more than 80...
Recently, as reported by dietetic departments in the United Kingdom, we have seen an increase in Homemade Blended Diets (HBD) being given to children requiring tube feeding. HBD practice may increase the risk of tube occlusion and nutritional inadequacies. In 2015 the British Dietetic Association (BDA) developed their first ‘Practice toolkit liquidised food via gastrostomy tube’, whic...