背景:喂养问题在有复杂医疗问题或急危重症的儿童中很常见,可能需要肠内营养。在某些情况下,胃管喂养耐受性差或可能不可行.尽管对口服和胃肠内治疗方案进行了适当调整,但当饲料不耐受持续存在时,空肠管喂养可以被认为是营养支持的一种选择。
方法:召开了澳大利亚肠外和肠内营养学会多学科专家工作组会议。他们确定了儿童空肠管喂养的主题问题和五个关键领域。在Pubmed上进行了文献检索,Embase,和所有相关研究的Medline,2000年1月至2022年9月(n=103)。研究使用国家卫生和医学研究委员会指南进行评估,以生成声明,作为一个小组讨论,然后使用修改后的Delphi程序对声明进行投票,以确定共识。
结果:针对五个关键领域共创建了24个共识声明:患者选择,进料管的类型和选择,并发症,临床使用空肠管,后续行动,和重新评估。
结论:在有复杂医疗需求的儿科患者中,空肠管喂养是一种安全有效的营养方式,不能用胃管喂养的人。适当的患者选择很重要,因为与空肠管喂养相关的并发症并不少见,虽然大多是未成年人,可能是重要的或需要重新插入管。所有接受空肠管喂养的儿童都应进行多学科小组评估和随访。
BACKGROUND: Feeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support.
METHODS: A multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council
guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine
consensus.
RESULTS: A total of 24
consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow-up, and reassessment.
CONCLUSIONS: Jejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow-up.