Nursing Care in Pediatric Enteral Nutrition

Öz

Enteral nutrition is the direct delivery of macro and micronutrients into the gastrointestinal system through a tube, catheter, or stoma. Enteral nutrition is a fundamental factor for accurate nutrition, growth, and development in children and is often the preferred method to meet nutritional needs following various illnesses or surgical interventions. This method is generally favored over parenteral nutrition because direct feeding helps maintain the normal functions of the gastrointestinal system and preserves the balance of intestinal flora. Enteral nutrition is a process that may commence in a hospital setting and continue at home. Nurses play an active role in every stage of this process. They take on crucial roles in selecting the appropriate enteral nutrition products and equipment, creating a suitable nutrition plan, and adapting it according to the patient's condition. Nurses also monitor the child's enteral nutrition process, identify potential complications early on, and intervene to prevent these complications. Planning and implementing nursing care based on current information ensure the effective management of enteral nutrition in children. This approach contributes to the reduction of complications, shorter hospital stays, and improved quality of life for the child. Therefore, it is vital for nurses to keep their knowledge and skills in enteral nutrition up-to-date and be familiar with best practices in the field. This review aims to emphasize the significance of enteral nutrition and nursing care in children while presenting state of the art knowledge in the field.

Anahtar Kelimeler

• Nutrition
• enteral
• critically ill child

Destekleyen Kurum

This research did not receive support from any funding agency/industry.

Etik Beyan

This is a review article.

Çocuklarda Enteral Beslenme ve Hemşirelik Bakımı

Öz

Enteral beslenme, makro ve mikro besin öğelerinin tüp, kateter ya da stoma yolu ile gastrointestinal sisteme direkt olarak verilmesidir. Enteral beslenme, çocuklarda doğru beslenme, büyüme ve gelişme için temel bir faktördür ve genellikle çeşitli hastalıklar veya cerrahi müdahaleler sonrasında beslenme ihtiyacını karşılamak için tercih edilen bir yöntemdir. Bu yöntem, genellikle parenteral beslenme yöntemine tercih edilir çünkü doğrudan beslenme, gastrointestinal sistemin normal fonksiyonlarını sürdürmeye yardımcı olur ve bağırsak florasının dengesini korur. Enteral beslenme, hastane ortamında başlayan ve evde de devam edebilen bir süreçtir. Hemşireler, bu sürecin her aşamasında aktif bir rol oynamaktadırlar. Enteral beslenme ürünleri ve ekipmanlarının doğru bir şekilde seçilmesi, uygun bir beslenme planının oluşturulması ve hastanın durumuna göre adaptasyonun sağlanması konusunda hemşireler önemli roller üstlenirler. Hemşireler ayrıca, çocuğun enteral beslenme sürecini izler, potansiyel komplikasyonları erkenden tanımlar ve müdahalede bulunarak bu komplikasyonların önüne geçerler. Hemşirelik bakımının güncel bilgiler doğrultusunda planlanması ve uygulanması, çocuklarda enteral beslenme sürecinin etkili bir şekilde yönetilmesini sağlar. Bu, komplikasyonların azaltılmasına, hastanede kalış süresinin kısalmasına ve çocuğun yaşam kalitesinin artmasına katkıda bulunur. Bu nedenle, hemşirelerin enteral beslenme konusundaki bilgi ve becerilerini güncel tutmaları ve bu alandaki en iyi uygulamalara hakim olmaları, çocukların sağlıklı bir şekilde büyümeleri ve gelişmeleri için hayati öneme sahiptir. Bu derleme, çocuklarda enteral beslenme ve hemşirelik bakımının önemini vurgulayarak, bu alandaki güncel bilgileri sunmayı amaçlamaktadır.

Anahtar Kelimeler

• Beslenme
• enteral
• kritik çocuk hasta

Destekleyen Kurum

Herhangi bir kurum ya da kuruluştan finansal destek alınmamıştır.

Etik Beyan

Bu bir derleme makalesidir.

Kaynakça

1. Abera, E. G., & Sime, H. (2023). The prevalence of malnutrition among critically ill children: A systematic review and meta-analysis. BMC Pediatrics, 23(1), 583. https://doi.org/10.1186/s12887-023-04419-x
2. Ağın, H., Arslanköylü, A. E., Aşılıoğlu Yener, N., Anıl, A. B., Dursun, O., Kendirli, T., & Yıldızdaş, D. (2023). Çocuk Yoğun Bakım Ünitelerinde Beslenme Protokolü. Türk Çocuk Acil Tıp ve Yoğun Bakım Derneği. Erişim Adresi: https://cayd.org.tr/files/kritik-hasta-cocuklarda-beslenme-protokolu-YP.pdf Erişim Tarihi: 25 Aralık 2024.
3. Agustin, D. A. (2018). The role of nurses in providing health education to the family about the children enteral nutrition. International Journal of Advancement in Life Sciences Research, 1(2), 13-19. https://doi.org/10.31632/ijalsr.2018v01i02.003
4. Ari, H. F., Ağin, H., Ceylan, G., Atakul, G., Saraç Sandal, Ö., Sari, F., İŞgüder, R., & Çolak, M. (2022). Nutritional status and malnutrition assessment of patients followed in pediatric ıntensive care unit. Harran Üniversitesi Tıp Fakültesi Dergisi, 19(1), 56-60. https://doi.org/10.35440/hutfd.1068515
5. Albert, B., & Mehta, N. (2017). Nutrition in the critically ill child. In B. P. Fuhrman & J. J. Zimmerman (Ed.), Fuhrman and Zimmerman’s Pediatric Critical Care. 6th Edition, Elsevier; 1177-1188.e10.
6. Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., Metheny, N. A., Mueller, C., Robbins, S., Wessel, J., & the A.S.P.E.N. Board of Directors. (2009). ASPEN enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutrition, 33(2), 122-167. https://doi.org/10.1177/0148607108330314
7. Boullata, J. I., Carrera, A. L., Harvey, L., Escuro, A. A., Hudson, L., Mays, A., McGinnis, C., Wessel, J. J., Bajpai, S., Beebe, M. L., Kinn, T. J., Klang, M. G., Lord, L., Martin, K., Pompeii-Wolfe, C., Sullivan, J., Wood, A., Malone, A., Guenter, P., & ASPEN Safe Practices for Enteral Nutrition Therapy Task Force, American Society for Parenteral and Enteral Nutrition. (2017). ASPEN safe practices for enteral nutrition therapy. Journal of Parenteral and Enteral Nutrition, 41(1), 15-103. https://doi.org/10.1177/0148607116673053
8. Braegger, C., Decsi, T., Dias, J. A., Hartman, C., Kolacek, S., Koletzko, B., Koletzko, S., Mihatsch, W., Moreno, L., Puntis, J., Shamir, R., Szajewska, H., Turck, D., van Goudoever, J., & Nutrition, E. C. on. (2010). Practical approach to paediatric enteral nutrition: A comment by the ESPGHAN committee on nutrition. Journal of Pediatric Gastroenterology and Nutrition, 51(1), 110. https://doi.org/10.1097/MPG.0b013e3181d336d2

9. Chesser, H., Abdulhussein, F., Huang, A., Lee, J. Y., & Gitelman, S. E. (2021). Continuous glucose monitoring to diagnose hypoglycemia due to late dumping syndrome in children after gastric surgeries. Journal of the Endocrine Society, 5(3), 1-8. https://doi.org/10.1210/jendso/bvaa197
10. Child Health Patient Safety Organization. (2012). Patient safety action alert—blind pediatric ng tube placements – continue to cause harm. Erişim Adresi: https://www.childrenshospitals.org/-/media/files/migration/childhealthpso_blindpediatricngtubeplacements_patientsafetyalert_wattachment_08012012.pdf Erişim Tarihi: 25 Kasım 2022.
11. Chourdakis, M., Hecht, C., Gerasimidis, K., Joosten, K. F., Karagiozoglou-Lampoudi, T., Koetse, H. A., Ksiazyk, J., Lazea, C., Shamir, R., Szajewska, H., Koletzko, B., & Hulst, J. M. (2016). Malnutrition risk in hospitalized children: Use of 3 screening tools in a large European population. The American Journal of Clinical Nutrition, 103(5), 1301-1310. https://doi.org/10.3945/ajcn.115.110700
12. Diamanti, A., Di Ciommo, V. M., Tentolini, A., Lezo, A., Spagnuolo, M. I., Campanozzi, A., Panetta, F., Sole Basso, M., Elia, D., & Gambarara, M. (2013). Home enteral nutrition in children: A 14-year multicenter survey. European Journal of Clinical Nutrition, 67(1), 53-57. https://doi.org/10.1038/ejcn.2012.184
13. Erkan, T. (2017). Yoğun bakımdaki çocuk hastanın beslenmesi. Türkiye Klinikleri Pediatrik Bilimler - Özel Konular, 13(3), 194-200.
14. Fayazi, S., Adineh, M., Zahraei Fard, S., Farokh payam, H., & Ahmadie Batvandy, Z. (2016). Comparing two methods of enteral nutrition in terms of their complications and the time needed to reach goal calorie in children hospitalized in ICU. International Journal of Pediatrics, 4(7), 2119-2130. https://doi.org/10.22038/ijp.2016.7042
15. Gavhi, F., Kuonza, L., Musekiwa, A., & Motaze, N. V. (2020). Factors associated with mortality in children under five years old hospitalized for Severe Acute Malnutrition in Limpopo province, South Africa, 2014-2018: A cross-sectional analytic study. PLOS ONE, 15(5), e0232838. https://doi.org/10.1371/journal.pone.0232838
16. Gürkan, A., & Gülseven, B. (2013). Enteral beslenme: Bakımda güncel yaklaşımlar. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 16(2), 116-122.
17. Horn, D., Chaboyer, W., & Schluter, P. J. (2004). Gastric residual volumes in critically ill paediatric patients: A comparison of feeding regimens. Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses, 17(3), 98-103. https://doi.org/10.1016/s1036-7314(04)80011-0
18. Ichimaru, S. (2018). Methods of enteral nutrition administration in critically ill patients: Continuous, cyclic, intermittent, and bolus feeding. Nutrition in Clinical Practice, 33(6), 790-795. https://doi.org/10.1002/ncp.10105
19. Ichimaru, S., & Amagai, T. (2015). Intermittent and bolus methods of feeding in critical Care. In R. Rajendram, V. R. Preedy, & V. B. Patel (Ed.), Diet and Nutrition in Critical Care. New York. Springer; 535-548. https://doi.org/10.1007/978-1-4614-7836-2_139
20. Irving, S. Y., Lyman, B., Northington, L., Bartlett, J. A., Kemper, C., & Novel Project Work Group. (2014). Nasogastric tube placement and verification in children: Review of the current literature. Critical Care Nurse, 34(3), 67-78. https://doi.org/10.4037/ccn2014606
21. Jouancastay, M., Guillot, C., Machuron, F., Duhamel, A., Baudelet, J.-B., Leteurtre, S., & Recher, M. (2021). Are nutritional guidelines followed in the pediatric intensive care unit? Frontiers in Pediatrics, 9, 648867. https://doi.org/10.3389/fped.2021.648867
22. Kamat, P., Favaloro-Sabatier, J., Rogers, K., & Stockwell, J. A. (2008). Use of methylene blue spectrophotometry to detect subclinical aspiration in enterally fed intubated pediatric patients. Pediatric Critical Care Medicine: A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 9(3), 299-303. https://doi.org/10.1097/PCC.0b013e318172d500
23. Karadayı, A., & Türker, P. F. (2016). Dumping sendromunda nutrisyon. Güncel Gastroenteroloji, 20(3), 227-233. https://guncel.tgv.org.tr/journal/67/pdf/100472.pdf
24. Koç, N. (2022). Enteral beslenme. Türkiye Klinikleri Beslenme ve Diyetetik - Özel Konular, 8(2), 61-65. Koçhan, E., & Akın, S. (2018). Hemşirelerin enteral ve parenteral beslenme uygulamalarına ilişkin bilgi düzeylerinin değerlendirilmesi. Journal of Academic Research in Nursing, 4(1), 1-14. https://doi.org/10.5222/jaren.2018.001
25. Martinez, E. E., Bechard, L. J., Brown, A.-M., Coss-Bu, J. A., Kudchadkar, S. R., Mikhailov, T. A., Srinivasan, V., Staffa, S. J., Verbruggen, S. (Sascha) C. A. T., Zurakowski, D., & Mehta, N. M. (2022). Intermittent versus continuous enteral nutrition in critically ill children: A pre-planned secondary analysis of an international prospective cohort study. Clinical Nutrition, 41(12), 2621-2627. https://doi.org/10.1016/j.clnu.2022.09.018
26. Meert, K. L., Daphtary, K. M., & Metheny, N. A. (2004). Gastric vs small-bowel feeding in critically ill children receiving mechanical ventilation: A randomized controlled trial. Chest, 126(3), 872-878. https://doi.org/10.1378/chest.126.3.872
27. Mehta, N. M., Corkins, M. R., Lyman, B., Malone, A., Goday, P. S., Carney, L. (Nieman), Monczka, J. L., Plogsted, S. W., Schwenk, W. F., & the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. (2013). Defining pediatric malnutrition. Journal of Parenteral and Enteral Nutrition, 37(4), 460-481. https://doi.org/10.1177/0148607113479972
28. Mehta, N. M., Skillman, H. E., Irving, S. Y., Coss-Bu, J. A., Vermilyea, S., Farrington, E. A., McKeever, L., Hall, A. M., Goday, P. S., & Braunschweig, C. (2017). Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 41(5), 706-742. https://doi.org/10.1177/0148607117711387
29. Mikhailov, T. A., Kuhn, E. M., Manzi, J., Christensen, M., Collins, M., Brown, A.-M., Dechert, R., Scanlon, M. C., Wakeham, M. K., & Goday, P. S. (2014). Early enteral nutrition is associated with lower mortality in critically ill children. JPEN. Journal of Parenteral and Enteral Nutrition, 38(4), 459-466. https://doi.org/10.1177/0148607113517903
30. Moreno, Y. M. F., Ventura, J. C., Oliveira, L. D. de A., Silveira, T. T., & Hauschild, D. B. (2020). Undernutrition in critically ill children. Pediatric Medicine, 3, Article 22. https://doi.org/10.21037/pm-20-66
31. Morphet, J., Clarke, A. B., & Bloomer, M. J. (2016). Intensive care nurses’ knowledge of enteral nutrition: A descriptive questionnaire. Intensive and Critical Care Nursing, 37, 68-74. https://doi.org/10.1016/j.iccn.2016.07.001
32. Page, B., Nawaz, R., Haden, S., Vincent, C., & Lee, A. C. H. (2019). Paediatric enteral feeding at home: An analysis of patient safety incidents. Archives of Disease in Childhood, 104(12), 1174-1180. https://doi.org/10.1136/archdischild-2019-317090
33. Ren, C.-J., Yao, B., Tuo, M., Lin, H., Wan, X.-Y., & Pang, X.-F. (2021). Comparison of sequential feeding and continuous feeding on the blood glucose of critically ill patients: A non-inferiority randomized controlled trial. Chinese Medical Journal, 134(14), 1695-1700. https://doi.org/10.1097/CM9.0000000000001684
34. Rosen, D., Schneider, R., Bao, R., Burke, P., Ceballos, C., Hoffstadter-Thal, K., & Benkov, K. (2016). Home nasogastric feeds. Journal of Parenteral and Enteral Nutrition, 40(3), 350-354. https://doi.org/10.1177/0148607114551967
35. Saraç Sandal, Ö., Ongun, E. A., & Ceylan, G. (2022). Nutritional status of pediatric intensive care patients with chronic disease. Journal of Dr Behcet Uz Children s Hospital, 12(2), 128-135. https://doi.org/10.4274/buchd.galenos.2022.36459
36. Sevinç, E., Urgancı, N., & Erkan, T. (2019). Çocuklarda enteral beslenme rehberi. Türk Çocuk Gastroenteroloji, Hepatoloji ve Beslenme Derneği.
37. Sewify, K., & Genena, D. (2017). Open versus closed tube feeding in critically ill patients–which is the best? Journal of Nutrition & Food Sciences, 7(4). https://doi.org/10.4172/2155-9600.1000621
38. Sharda, L. S. (2020). Enteral Beslenme. İçinde P. Q. Samour & K. King (Ed.), & M. Saka (Çev.), Pediatrik beslenmenin esasları. 1. Baskı, Ankara. Nobel Akademik Yayıncılık; 270-288.
39. Simpson, F., & Doig, G. S. (2005). Parenteral vs. enteral nutrition in the critically ill patient: A meta-analysis of trials using the intention to treat principle. Intensive Care Medicine, 31(1), 12-23. https://doi.org/10.1007/s00134-004-2511-2
40. Sinha, S., Lath, G., & Rao, S. (2020). Safety of enteral nutrition practices: Overcoming the contamination challenges. Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(8), 709-712. https://doi.org/10.5005/jp-journals-10071-23530
41. Sönmez Düzkaya, D., & Yıldız, S. (2016). Effect of two different feeding methods on preventing ventilator associated pneumonia in the paediatric intensive care unit (PICU): A randomised controlled study. Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses, 29(3), 139-145. https://doi.org/10.1016/j.aucc.2015.11.001
42. Ten Haken, I., Ben Allouch, S., & van Harten, W. H. (2018). The use of advanced medical technologies at home: A systematic review of the literature. BMC Public Health, 18(1), 284. https://doi.org/10.1186/s12889-018-5123-4
43. The American Association of Critical-Care Nurses. (2016). Prevention of aspiration in adults. Critical Care Nurse, 36(1), e20-e24. https://doi.org/10.4037/ccn2016831
44. Tume, L. N., & Valla, F. V. (2018). A review of feeding intolerance in critically ill children. European Journal of Pediatrics, 177(11), 1675-1683. https://doi.org/10.1007/s00431-018-3229-4
45. Tume, L. N., Valla, F. V., Joosten, K., Jotterand Chaparro, C., Latten, L., Marino, L. V., Macleod, I., Moullet, C., Pathan, N., Rooze, S., van Rosmalen, J., & Verbruggen, S. C. A. T. (2020). Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Medicine, 46(3), 411-425. https://doi.org/10.1007/s00134-019-05922-5
46. Uncuoğlu, A., Kutluk, G., & Uğraş, M. (2019). Çocukluk çağında kullanılan enteral beslenme ürünleri rehberi. Türk Çocuk Gastroenteroloji, Hepatoloji ve Beslenme Derneği.
47. Uslu Kızılkan, N., Yılmaz, A., & Demir, H. (2020). Çocuk yoğun bakım ünitesinde beslenme rehberi. Türk Çocuk Gastroenteroloji, Hepatoloji ve Beslenme Derneği.
48. Veldscholte, K., Cramer, A. B. G., de Jonge, R. C. J., Eveleens, R. D., Joosten, K. F. M., & Verbruggen, S. C. A. T. (2022). Continuous versus intermittent nutrition in pediatric intensive care patients: Protocol for a randomized controlled trial. JMIR Research Protocols, 11(6), e36229. https://doi.org/10.2196/36229
49. Vermilyea, S., & Goh, V. L. (2016). Enteral feedings in children—Sorting out tubes, buttons, and formulas. Nutrition in Clinical Practice, 31(1), 59-67. https://doi.org/10.1177/0884533615604806
50. Volpe, A., & Malakounides, G. (2018). Feeding tubes in children. Current Opinion in Pediatrics, 30(5), 665. https://doi.org/10.1097/MOP.0000000000000666
51. Yakut, T., & Sönmez Düzkaya, D. (2022). Enteral beslenme. Türkiye Klinikleri Çocuk Sağlığı ve Hastalıkları Hemşireliği - Özel Konular, 8(2), 18-27.
52. Yamoto, M., Fukumoto, K., Takahashi, T., Miyake, H., Nakaya, K., Nomura, A., Sekioka, A., Yamada, Y., & Urushihara, N. (2021). Risk factors of dumping syndrome after fundoplication for gastroesophageal reflux in children. Pediatric Surgery International, 37(2), 183-189. https://doi.org/10.1007/s00383-020-04783-0
53. Yeşilbaş, O. (2020). Çocuk Yoğun Bakımdaki Hastanın Beslenmesi. İçinde O. Özkaya, M. Sütçü, & H. U. Hatipoğlu (Ed.), Çocuklarda A’dan Z’ye Beslenme. Ankara. Akademisyen Kitabevi; 269-279.
54. Yi, D. Y. (2018). Enteral nutrition in pediatric patients. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 12-19. https://doi.org/10.5223/pghn.2018.21.1.12