Disease-associated undernutrition in children results from disease-specific factors, decreased intake and increased losses with or without inflammation. The assessment of nutritional status should be based on more than a single anthropometric measurement, and rather with serial measurements taken over time. The analysis of growth using growth curves and/or z-scores remains the cornerstone for a paediatric nutritional assessment. Nutritional risk screening should be imbedded in any nutritional care algorithm and the important role of the paediatric nutrition support team cannot be overemphasized.
PN is an essential and often life-saving treatment for infants, children and adolescents who cannot be adequately fed orally or enterally.
PN should only be used when all alternative options have been explored, including adequate care, specialised enteral nutrition, and artificial feeding devices.
PN can induce severe adverse effects. The risk is reduced by a meticulous approach, establishment of a multidisciplinary nutrition support team, avoidance of unbalanced or excessive substrate supplies, and the use of strict hygiene measures to reduce catheter infections, concomitant minimal enteral feeding and aggressive enhancement of enteral feeding where possible to limit the amount and duration of PN.
In this module various aspects of enteral nutrition in paediatric patients are discussed. Indications, contraindications, administration of EN, monitoring and complications are described. The nutrient composition of various enteral formulas is presented and criteria for enteral formula selection are described.
Various aspects of the alterations of the metabolism of critically ill children and the consequences for enteral and parenteral nutrition are discussed. Principles of nutritional assessment are described and methods to calculate energy expenditure are given. Indications, contraindications and recommendations for the administration of enteral and parenteral nutrition are described.