Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

European Journal of Clinical Nutrition volume 62, pages 395–400 (2008)Cite this article

Abstract

Objective:

To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children.

Design:

A prospective, observational study.

Setting:

Pediatric intensive care unit

Subjects:

Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN).

Methods:

Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications

Results:

Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 μg/kg/min and hypophosphatemia.

Conclusions:

The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • Artinian V, Krayem H, DiGiovine B (2006). Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest 129, 960–967.

    Article  Google Scholar 

  • Barak V, Schwartz A, Kalickman I, Nisman B, Gurman G, Shoenfeld Y (1998). Prevalence of hypophosphatemia in sepsis and infection: the role of cytokines. Am J Med 104, 40–47.

    Article  CAS  Google Scholar 

  • Berger MM, Revelly JP, Cayeux MC, Chiolero RL (2005). Enteral nutrition in critically ill patients with severe hemodynamic failure after cardiopulmonary bypass. Clin Nutr 24, 124–132.

    Article  Google Scholar 

  • Body JJ, Cryer PE, Offord KP, Heath III H (1983). Epinephrine is a hypophosphatemic hormone in man. Physiological effects of circulating epinephrine on plasma calcium, magnesium, phosphorus, parathyroid hormone, and calcitonin. J Clin Invest 71, 572–578.

    Article  CAS  Google Scholar 

  • Borrego R, López-Herce J, Mencía S, Carrillo A, Sancho L, Bustinza A (2006). Severe ischemia of the lower limb and of the intestine associated with systemic vasoconstrictor therapy and femoral arterial catheterization. Pediatr Crit Care Med 7, 267–269.

    Article  Google Scholar 

  • Briassoulis G, Zavras N, Hatzis T (2001). Malnutrition, nutritional indices and early enteral feeding in critically ill children. Nutrition 17, 548–557.

    Article  CAS  Google Scholar 

  • Briassoulis G, Filippou O, Hatzi E, Papassotiriou I, Hatzis T (2005). Early enteral administration of inmunonutrition in critically ill children: results of a blinded randomized controlled clinical trial. Nutrition 21, 799–807.

    Article  Google Scholar 

  • Chellis MJ, Sanders SV, Webster H, Dean JM, Jackson D (1996). Early enteral feeding in the pediatric intensive care unit. JPEN 20, 71–73.

    Article  CAS  Google Scholar 

  • Davies AR, Froomes PR, French CJ, Bellomo R, Gutteridge GA, Nyulasi I et al (2002). Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 30, 586–590.

    Article  Google Scholar 

  • De Lucas C, Moreno M, López-Herce J, Ruiz F, Pérez-Palencia M, Carrillo A (2000). Transpyloric enteral nutrition reduces the complication rate and cost in the critically ill child. J Pediatr Gastroenterol Nutr 30, 175–180.

    Article  CAS  Google Scholar 

  • Fernández C, López-Herce J, Flores JC, Galaviz D, Rupérez M, Brandstrup KB et al (2005). Prognosis in critically ill children requiring continuous renal replacement therapy. Pediatr Nephrol 20, 1473–1477.

    Article  Google Scholar 

  • Fiaccadori E, Maggiore U, Giacosa R, Rotelli C, Picetti E, Sagripanti S et al (2004). Enteral nutrition in patients with acute renal failure. Kidney Int 65, 999–1008.

    Article  Google Scholar 

  • Flores JC, López-Herce J, Sola I, Carrillo Jr A (2006). Duodenal perforation caused by a transpyloric tube in a critically ill infant. Nutrition 22, 209–212.

    Article  Google Scholar 

  • Galbán C, Montejo JC, Mesejo A, Marco P, Celaya S, Sánchez-Segura JM et al (2000). An inmune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 28, 643–648.

    Article  Google Scholar 

  • Hadfield RJ, Sinclair DG, Houldsworth PE, Evans TW (1995). Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill. Am J Respir Crit Care Med 152, 1545–1548.

    Article  CAS  Google Scholar 

  • Ho KM, Dobb GJ, Webb SAR (2006). A comparison of early gastric and post-pyloric feeding in critically ill patients: a meta-analysis. Intensive Care Med 32, 639–649.

    Article  Google Scholar 

  • Kles KA, Wallig MA, Tappenden KA (2001). Luminal nutrients exacerbate intestinal hypoxia in the hypoperfused jejunum. JPEN 25, 246–253.

    Article  CAS  Google Scholar 

  • Kraft MD, Btaiche IF, Sacks GS (2005). Review of the refeeding syndrome. Nutr Clin Pract 20, 625–633.

    Article  Google Scholar 

  • Marik PE, Bedigian MK (1996). Refeeding hypophosphatemia in critically ill patients in an intensive care unit. A prospective study. Arch Surg 131, 1043–1047.

    Article  CAS  Google Scholar 

  • McClave SA, Chang WK (2003). Feeding the hypotensive patient: does enteral feeding precipitate or protect against ischemic bowel? Nutr Clin Pract 18, 279–284.

    Article  Google Scholar 

  • McGuire W, McEwan P (2004). Systematic review of transpyloric versus gastric tube feeding for preterm infants. Arch Dis Child Fetal Neonatal Ed 89, F245–F248.

    Article  CAS  Google Scholar 

  • Meert KL, Daphtary KM, Metheny NA (2004). Gastric vs small-bowel feeding in critically ill children receiving mechanical ventilation: a randomized controlled trial. Chest 126, 872–878.

    Article  Google Scholar 

  • Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001). Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors and complications. Crit Care Med 29, 1955–1961.

    Article  CAS  Google Scholar 

  • Montejo JC, The nutritional metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units (1999). Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. Crit Care Med 27, 1447–1453.

    Article  CAS  Google Scholar 

  • Montejo JC, Grau T, Acosta J, Ruiz-Santana S, Planas M, García-De-Lorenzo A et al (2002). Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients. Crit Care Med 30, 796–800.

    Article  Google Scholar 

  • ÓLeary-Kelley CM, Puntillo KA, Barr J, Stotts N, Douglas MK (2005). Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally. Am J Crit Care 14, 222–230.

    Google Scholar 

  • Pérez-Navero JL, Dorao Martínez-Romillo P, López-Herce Cid J, Ibarra de la Rosa I, Pujol Jover M, Grupo de Trabajo de Nutrición de la Sociedad Española de Cuidados Intensivos Pediátricos (2005). Nutrición artificial en las unidades de cuidados intensivos pediátricos. An Pediatr (Barcelona) 62, 105–112.

    Article  Google Scholar 

  • Rogers EJ, Gilbertson HR, Heine RG, Henning R (2003). Barriers to adequate nutrition in critically ill children. Nutrition 19, 865–868.

    Article  Google Scholar 

  • Rokyta Jr R, Matejovic M, Krouzecky A, Novak I (2003). Enteral nutrition and hepatosplanchnic region in critically ill patients – friends or foes? Physiol Res 52, 31–37.

    PubMed  Google Scholar 

  • Sánchez C, Panadero E, Hortelano M, García E, Izquierdo A, López-Herce J (1998). Enterocolitis necrotizante en el postoperatorio de cirugía cardíaca en el periodo neonatal. An Esp Pediatr 49, 185–187.

    Google Scholar 

  • Sánchez C, López-Herce J, Moreno de Guerra M, Carrillo A, Moral R, Sancho L (2000). The use of transpyloric enteral nutrition in the critically ill child. J Intensive Care Med 15, 247–254.

    Article  Google Scholar 

  • Sánchez Sánchez C, López-Herce Cid J, Carrillo Álvarez A, Bustinza Arriortúa A, Sancho Pérez L, Vigil Escribano D (2003). Nutrición enteral transpilórica en el niño críticamente enfermo (II): complicaciones. An Pediatr (Barcelona) 59, 25–30.

    Article  Google Scholar 

  • Sánchez C, López-Herce J, García C, Rupérez M, García E (2005). The effect of enteral nutrition on nutritional status in the critically ill child. Clin Intensive Care 16, 75–78.

    Article  Google Scholar 

  • Spalding HK, Sullivan KJ, Soremi O, Gonzalez F, Goodwin SR (2000). Bedside placement of transpyloric feeding tubes in the pediatric intensive care unit using gastric insufflation. Crit Care Med 28, 2041–2046.

    Article  CAS  Google Scholar 

  • Van Vlem B, Schoonjans R, Vanholder R, De Vos M, Vandamme W, Van Laecke S et al (2000). Delayed gastric emptying in dyspectic chronic hemodialysis patients. Am J Kidney Dis 36, 962–968.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the nurses and doctors of the Pediatric Intensive Care Department for their collaboration in performing this study.

Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, Preventive and Quality Control Service (DV), Gregorio Marañón General University Hospital, Madrid, Spain

    J López-Herce, M J Santiago, C Sánchez, S Mencía, A Carrillo & D Vigil

Authors
  1. J López-Herce
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M J Santiago
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Mencía
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Carrillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D Vigil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J López-Herce.

Rights and permissions

Reprints and permissions

About this article

Cite this article

López-Herce, J., Santiago, M., Sánchez, C. et al. Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition. Eur J Clin Nutr 62, 395–400 (2008). https://doi.org/10.1038/sj.ejcn.1602710

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602710

Keywords

This article is cited by

Search

Advanced search

Quick links