Nutrition for the pediatric surgical patient: approach in the peri-operative period.
نویسندگان
چکیده
Nutrition is essential for maintenance of physiologic homeostasis and growth. Hypermetabolic states lead to a depletion of body stores, with decreased immunocompetence and increased morbidity and mortality. The purpose of this paper is to provide an update regarding the provision of appropriate nutrition for the pediatric surgical patient, emphasizing the preoperative and postoperative periods. Modern nutritional support for the surgical patient comprises numerous stages, including assessment of nutritional status, nutritional requirements, and nutritional therapy. Nutritional assessment is performed utilizing the clinical history, clinical examination, anthropometry, and biochemical evaluation. Anthropometric parameters include body weight, height, arm and head circumference, and skinfold thickness measurements. The biochemical evaluation is conducted using determinations of plasma levels of proteins, including album, pre-albumin, transferrin, and retinol-binding protein. These parameters are subject to error and are influenced by the rapid changes in body composition in the peri-operative period. Nutritional therapy includes enteral and/or parenteral nutrition. Enteral feeding is the first choice for nutritional therapy. If enteral feeding is not indicated, parenteral nutrition must be utilized. In all cases, an individualized, adequate diet (enteral formula or parenteral solution) is obligatory to decrease the occurrence of overfeeding and its undesirable consequences.
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In summary, therefore, the provision of TPN to malnourished patients in the pre-operative period reduces the incidence of post-operative complications, but does not affect post-operative mortality. It is likely that the provision of nutrition by the enteral route is as effective as that by the parenteral route, and may have the extra benefit of resulting in a reduction in infectious complicatio...
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ورودعنوان ژورنال:
- Revista do Hospital das Clinicas
دوره 57 6 شماره
صفحات -
تاریخ انتشار 2002