Enteral nutrition support is used extensively in the care of infants and children,
both for acute and chronic conditions. Monitoring a child's tolerance of enteral
feedings is an ongoing challenge. Monitoring routines vary significantly between
institutions, practitioners, and patient settings, and a number of definitions are
used for “intolerance.” Some guidelines have scientific basis and others are passed
along in a more anecdotal fashion. This review describes commonly used monitors for
tolerance to enteral nutrition for infants and children and discusses pertinent data
relevant to practice.
Corrales KM, Duggan C. Enteral formula selection.
In: Corkins MR, Shulman RJ, eds. Pediatric Nutrition in Your Pocket.
Silver Spring, MD: American Society for Parenteral and Enteral
Nutrition;2002 : 94–109.
3.
Shulman RJ, Phillips S. Enteral and parenteral
nutrition. In: Lifschitz CH, ed. Pediatric Gastroenterology and Nutrition in
Clinical Practice. New York, NY: Marcel Dekker;2002 :
417–450.
4.
Mascarenhas MR, Kerner JA, Stallings VA. Parenteral
and enteral nutrition. In: Walker WA, Durie PR, Hamilton JR, Walker-Smith JA, et al,
eds. Pediatric Gastrointestinal Disease. 3rd ed.
Hamilton, Ontario: BC Decker; 2000:1726–
1752.
5.
A.S.P.E.N. Board of Directors. Standards for
hospitalized pediatric patients. Nutr Clin Pract.1996 ;11:217– 228.
6.
Montejo JC. Enteral nutrition-related
gastrointestinal complications in critically ill patients: a multicenter study.
Crit Care Med.1999;27:1447– 1453.
7.
McClave SA, Sexton LK, Spain DA, et al. Enteral tube
feeding in the intensive care unit: factors impeding adequate delivery. Crit
Care Med.1999;27:1252– 1256.
8.
Pinilla JC, Samphire J, Arnold C, Liu L, Theissen B.
Comparison of gastrointestinal tolerance to two enteral feeding protocols in
critically ill patients: a prospective, randomized controlled trial. JPEN J
Parenter Enteral Nutr.2001 ;25:81– 86.
9.
McClave SA, Snider HL, Lowen CC, et al. Use of
residual volume as a marker for enteral feeding intolerance: prospective blinded
comparison with physical examination and radiographic findings. JPEN J
Parenter Enteral Nutr.1992;16:99– 105.
10.
Lin HC, Van Citters GW. Stopping enteral feeding for
arbitrary gastric residual volume may not be physiologically sound: results of a
computer simulation model. JPEN J Parenter Enteral Nutr.1997;21:286– 289.
11.
Burd RS, Lentz CW. The limitations of using gastric
residual volumes to monitor enteral feedings: a mathematical model. Nutr Clin
Pract.2001;16:349– 354.
12.
McClave SA, DeMeo MT, DeLegge MH, et al. North
American summit on aspiration in the critically ill patient: consensus statement.
JPEN J Parenter Enteral Nutr.2002 ;26(Suppl):S80–
S85.
13.
Premji SS, Paes B, Jacobson K, Chessell L.
Evidence-based feeding guidelines for very low-birth weight infants. Adv
Neonat Care.2002;2:5– 18.
14.
Hodges C, Vincent PA. Why do NICU nurses not refeed
gastric residuals prior to feeding by gavage? Neonat Netw.1993 ;12:37– 40.
15.
Mayo Foundation. Physician's Pediatric
Enteral Nutrition Order Sheet. Rochester, MN: Mayo Foundation;MC1507–
03.
16.
Baker JH, Berseth CL. Duodenal motor responses in
preterm infants fed formula with varying concentrations and rates of infusion.
Pediatr Res.1997 ;42:618– 622.
17.
Schanler RJ, Shulman RJ, Lau C, Smith EO, Heitkemper
MM. Feeding strategies for premature infants: randomized trial of gastrointestinal
priming and tube-feeding method. Pediatrics.1999 ;103:434– 439.
18.
Broussard DL. Gastrointestinal motility in the
neonate. Clin Perinatol.1995 ;22:37– 59.
19.
Khoshoo V, Brown S. Gastric emptying of two
whey-based formulas of different energy density and its clinical implication in
children with volume intolerance. Eur J Clin Nutr.2002 ;56:656– 658.
20.
Lyons KA, Brilli RJ, Wieman RA, Jacobs BR.
Continuation of transpyloric feeding during weaning of mechanical ventilation and
tracheal extubation in children: a randomized controlled trial. JPEN J
Parenter Enteral Nutr.2002 ;26:209– 213.
21.
Rayyis SF, Ambalavanan N, Wright L, Carlo WA.
Randomized trial of“ slow” versus “fast” feed advancements on the incidence of
necrotizing enterocolitis in very low birth weight infants. J
Pediatr.1999 ;134:293– 297.
22.
Heimburger DC, Sockwell DG, Geels WJ. Diarrhea with
enteral feeding: prospective reappraisal of putative causes.
Nutrition.1994 ;10:392– 396.
23.
Bliss DZ, Guenter PA, Settle RG. Defining and
reporting diarrhea in tube-fed patients: what a mess! Am J Clin
Nutr.1992 ;55:753– 759.
24.
Lebak KJ, Bliss DZ, Savik K, Patten-Marsh KM. What's
new on defining diarrhea in tube-feeding studies? Clin Nurs Res.2003; 12:174– 204.
25.
Horn D, Chaboyer W. Gastric feeding in critically
ill children: a randomized controlled trial. Am J Crit Care.2003 ;12:461– 468.
26.
Guenter PA, Sweed MR. A valid and reliable tool to
quantify stool output in tube-fed patients. JPEN J Parenter Enteral
Nutr.1998;22:147– 151.
27.
Bliss DZ, Johnson S, Savik K, Clabots CR, Willard K,
Gerding DN. Acquisition of Clostridium difficile and
Clostridium difficile-associated diarrhea in
hospitalized patients receiving tube feeding. Ann Intern Med.1998 ;129:1012– 1019.
28.
Marchand V, Baker SS, Baker RD. Enteral nutrition in
the pediatric population. Gastrointest Endosc Clin North Am.1998 ; 8:669– 703.
29.
Chessex P, Van Aerde JEE. Nutrition and feeding. In:
Perlman M, Kirpalani HM, Moore AM, eds. Residents Handbook of
Neonatology. 2nd ed. Hamilton, Ontario: BC
Decker;1999 : 97–118.
30.
Blondheim O, Abbasi S, Fox WW, Bhutani VK. Effect of
enteral gavage feeding rate on pulmonary functions of very low birth weight infants.
J Pediatr.1993 ;122:751– 755.
31.
Anderson DM. Nutrition support for neonates. In:
Matarese LE, Gottschlich MM, eds. Contemporary Nutrition Support
Practice. Philadephia, PA: W.B. Saunders;
1998:333– 346.
32.
Klotz KA, Wessel JJ, Hennies GA. Goals of pediatric
nutrition support and nutrition assessment. In: Merritt RJ, ed. The
A.S.P.E.N. Nutrition Support Practice Manual. Silver Spring, MD: American
Society for Parenteral and Enteral Nutrition; 1998:23-1–
23-14.
33.
Gibbons K, Cyr N, Christensen ML, Helms RA.
Techniques for pediatric enteral and parenteral nutrition. In: Merritt RJ, ed.
The A.S.P.E.N. Nutrition Support Practice Manual. Silver Spring,
MD: American Society for Parenteral and Enteral Nutrition;
1998:25-1– 25-10.
