Establishing early enteral nutrition with the use of self-advancing postpyloric feeding tube in critically ill children.

INTRODUCTION Early nutrition support is an integral part of the care of critically ill children. Early enteral nutrition (EN) improves nitrogen balance and prevents bacterial translocation and gut mucosal atrophy. Adequate EN is often not achieved as gastric feeds are not tolerated and placing postpyloric feeding tubes can be difficult. Spontaneous transpyloric passage of standard feeding tubes without endoscopic intervention or use of anesthesia can range from 30%-80%. The authors report on their experience with a 14Fr polyurethane self-advancing jejunal feeding tube in a pediatric population. These tubes have been used in the adult population with success, but to the authors' knowledge, there have been no reports of its use in the pediatric age group. CASE SERIES The authors present 7 critically ill patients 8-19 years old, admitted to the pediatric intensive care unit, in whom prolonged recovery, inability to tolerate gastric feeds, and dependence on ventilator were predicted at the outset. The jejunal feeding tube was successfully placed on first attempt at the bedside in all 7 patients within the first 24 hours without the use of a promotility agent or endoscopic intervention. Nutrition goal achieved within 48 hours of feeding tube placement was reported for each patient. This case series demonstrates that children fed via the small bowel reached their nutrition goal earlier and did not require parenteral nutrition. CONCLUSION The self-advancing jejunal feeding tube can be used effectively to establish early EN in critically ill children.