Enteral nutrition.

Enteral nutrition (EN) is defined as the delivery of nutrients beyond the oesophagus via feeding tubes, and the oral intake of dietary foods for special medical purposes. It should be provided in patients with at least a partially functioning gut, whose energy and nutrient needs cannot be met by a regular food intake. Further indications are when the liquid diet is used as a treatment of the disease, and when a feeding time in the disabled child is excessively prolonged. Advantages of enteral intake over parenteral nutrition are well recognized, however there are clinical settings such as intensive care units where nutritional needs can often be met only by their combination despite the functioning gut. For the majority of paediatric patients on EN, age-adapted standard polymeric formula enriched with fibres is an appropriate choice. There is also a wide array of different disease-adapted enteral formulations that may be beneficial in certain clinical conditions, however for most of them, results of controlled studies are either missing or do not support the claims. For the delivery of EN, both the stomach and intermittent feeding mode are more physiological; continuous mode is reserved for patients with severely diseased gut, postpyloric feeding is indicated in patients with the high risk of tracheal aspiration, and feeding over gastrostomy is preferable if the anticipated duration of EN is exceeding 4-6 weeks. Although EN is a well-established and effective feeding method, it may be poorly tolerated and associated with numerous complications. To minimize the risks, development of procedural protocols with regular quality controls and audits, and monitoring by a dedicated nutrition support team are recommended.