Clinical Study Of Application Of Enteral Nutrition In Pediatric Surgery

ObjectiveNutrition is the basic material to maintain the human growth and development, homeostasis and normal metabolism. Because of the specificity of the growing phase, the nutrition need for children is unique. Since the state of stress severe infection, trauma, surgical strike, etc., energy consumption quickly, and some children can not intake of food by mouth, immune system and vital organs of surgical patients been affected, prone to infection and nutrition-related complications, prolonged hospitalization and increased mortality. It has important value to take the right steps to correct the nutritional deficiency for ensure the normal metabolism of cells, maintaining the normal structure and function of tissues and organs, maintaining the immune function, promote tissue, organ healing and recovery from disease. Enteral nutrition is considered as a means of nutrition treatment to correct malnutrition, promote gastrointestinal development, meet the physiological requirements, fewer complications, and more economical. The purpose of this study is to investigate the value, reliability, application, advantages, complications and precautions of enteral nutrition in pediatric surgery.Methods1. Retrospective analysis of the clinical data of 78 patients of pediatric surgery with nasal jejunal nutrient tube in the treatment of enteral nutrition in our hospital from June 2007 to February 2014.2. Nutrient choices and give way:We choose the Aiershu (mainly short peptide or amino acid) of Nestle company to less than 1 year old children and choose small peptide of Nestle company or Nutrison (mainly short peptide) of Nutricia company to over 1 year old children by pumped uniformly though nasal jejunal nutrient tube for 24 hours a day.3. The tolerance of enteral nutrition:Recording such as gastric retention, abdominal distension, vomiting, the characters and frequency of stools for the tolerance of enteral nutrition.4. Nutrition indicators:Nutrition indicators include weight, red blood cell count(RBC), hemoglobin(HGB), serum lymphocyte count(SLC), serum albumin(SA), prealbumin (PA), blood serum creatinine(BSC), blood urea nitrogen(BUN), before and after enteral nutrition.5. Statistical Analysis:All data were expressed as the mean±SD. Groups (before EN vs after EN, before fasting vs after fasting)were analyzed using a paired t-test. A P value of 0.05 was considered significant. A P value of 0.01 was considered a statistically significant.Result1. Baseline date1.1 There were 53 males and 25 females in the treatment of enteral nutrition with nasal jejunal tube from June 2007 to February 2014. The age is 1 day to 9 years (2.9±2.4) years and the weight is (12.70±6.92)kg before EN treatment. Among these 78 cases, pancreatitis 22 cases, small intestine atresial4 cases, liver contusion and laceration in 10 cases, duodenal diaphragm stenosis in 9 cases, hepatoblastoma in 5 cases, annular pancreas in 6 cases, duodenal perforation in 6 cases, esophageal atresia in 6 cases.1.2 EN treatment time:78 patients were completed by EN treatment successfully. EN treatment time were 7?37d (17.5±9.4) d,21 patients in the 10d,19 patients in the 10-15d and 38 patients more than 15d.1.3 Adverse reactions:6 patients (7.7%) had diarrhea, the symptoms were yellow or green dilute about 50 ml/kg for 6 to 8 times a day; 4 patients (5.1%) had nausea and vomit transparent or yellow liquid, the amount of residual nutrient fluid was one times of the amount of nutrient fluid in the unit time; 5 patients (6.4%) had mild abdominal distension, abdominal circumference is 2.5cm greater than the standard though two consecutive measurements; 6 patients (7.7%) had slight abdominal pain; 4 patients (5.1%) had low sodium and low potassium, but no aspiration pneumonia and no gastrointestinal bleeding ect.2. Nutrition indicators before and after ENThere were significant differences in weight, red blood cell count(RBC), hemoglobin(HGB), serum albumin(SA), prealbumin (PA) before and after fast and without nutritional therapy of 39 patients (P<0.05); there was statistically significant differences in prealbumin (PA) (P<0.01); and there were no significant differences in serum lymphocyte count(SLC), blood serum creatinine(BSC), blood urea nitrogen(BUN) (P>0.05).There were no significant differences in weight, red blood cell count(RBC), serum lymphocyte count(SLC), hemoglobin(HGB), serum albumin(SA), blood serum creatinine(BSC), blood urea nitrogen(BUN) (P>0.05) before EN and after EN 3 days of 78 patients; there was statistically significant differences in prealbumin (PA) (P<0.01). In the short term (3d), the EN treatment failed to significantly change the nutritional status of children.There were significant differences in weight, red blood cell count(RBC), hemoglobin(HGB), serum albumin(SA), prealbumin (PA) before fasting and after EN 10d of 57 patients (P<0.05); there was statistically significant differences in red blood cell count(RBC), hemoglobin(HGB), serum albumin(SA), prealbumin (PA) (P<0.01); and there were no significant differences in serum lymphocyte count(SLC), blood serum creatinine(BSC), blood urea nitrogen(BUN) (P>0.05). After treatment with EN 10d, the nutritional status of the patients was significantly improved compared with before.There were significant differences in weight, serum albumin(SA), prealbumin (PA) before fasting and after EN more than 15d of 38 patients (P<0.05); there were no significant differences in red blood cell count(RBC), hemoglobin(HGB), serum lymphocyte count(SLC), blood serum creatinine(BSC), blood urea nitrogen(BUN) (P >0.05). Nutritional status of patients had improved afterEN 15d. EN nutrition can provide adequate nutrition for patients, and ensure their rehabilitation and normal growth and development.3. Treatment ResultsAfter EN 10d, the patients had a good mental state, no listlessness, malnutrition, anemia symptoms, nutritional status improved significantly, and weight increase compared with before. Some older patients can be normal ambulation without limbs weakness and other symptoms.Conclusion1. Enteral nutrition in pediatric surgery application is safe and effective, can provide nutrition for children with normal growth and development and tissue repair and healing, and promote the recovery of gastrointestinal function in children.2. Gastric retention, abdominal distension, abdominal pain, the volume and frequency of vomiting, the volume and frequency of stools can be good assessments of the tolerance of EN. They gave a help to find the discomfort of children and adjust the volume or the increase volume of formula, which is more advantageous to the treatment.3. In this study weight, RBC, HGB, SLC, SA, PA, TRF, BSC, BUN can very well reflect the nutritional status of the patients, and can be used as evaluation enteral nutrition of the clinical curative effect of nutrition index. Enteral nutrition is conducive to maintaining the integrity of the intestinal mucosa barrier function, reducing the release of endotoxins and bacteria ectopic, and to better promote the recovery of immune function.