Neurological impairment and malnutrition in children: The role of home enteral nutrition in real life

Antonella Diamanti; Teresa Capriati; Antonella Mosca; Chiara Maria Trovato; Francesca Laureti; Bianca Mazzoli; Giulia Bolasco; Tamara Caldaro; Francesco De Peppo; Susanna Staccioli; Raffaele Edo Papa; Antonella Cerchiari; Paola De Angelis; Giuseppe Maggiore

doi:10.3389/fnut.2023.1087603

Neurological impairment and malnutrition in children: The role of home enteral nutrition in real life

Front Nutr. 2023 Mar 22:10:1087603. doi: 10.3389/fnut.2023.1087603. eCollection 2023.

Affiliations

¹ Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
² Unit of Palidoro Pediatric Surgery, Department of Specialized Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
³ Department of Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy.
⁴ Pediatrics Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Abstract

Objective: Recent decades have brought an increased survival of children with Neurologic Impairment (NI) but malnutrition and digestive comorbidity remain important challenges to face. We designed the present study to assess the course of nutritional status following standardized Home Enteral Nutrition (HEN) program and to evaluate impact of changing mode of feeding, as a part of overall multidisciplinary management, on digestive co-morbidity as Gastro-Esophageal Reflux Disease (GERD), Oropharyngeal Dysphagia (OPD), constipation and airway aspiration.

Methods: We performed a retrospective analysis on NI children entered into Institutional HEN program due to NI disorders between January 2011 and 2019. Demographic, anthropometric characteristics (BMI z-score and weight for age z-score) and symptoms (GERD, OPD constipation and airway aspiration) were collected at the enrolment and during the follow up.

Results: We enrolled 402 patients (median age: 39 months); overall survival was 97%. Nutritional status was significantly improved by HEN; in particular growth profile significantly changed within the first 2 years following HEN beginning; GERD and airways aspirations decreased after HEN beginning. Constipation and OPD remained unchanged over time.

Conclusions: Malnutrition and digestive complaints are distinctive features of NI children. Nutritional status improve after 2 years from the beginning of standardized nutritional interventions. Overall multidisciplinary care, including standardized HEN protocols, seems to also impact on GERD and airway aspirations, which can decrease over time. It is possible that constipation and OPD, unchanged over time, are more dependent on underlying diseases than on overall treatments.

Keywords: enteral nutrition; gastro-esophageal reflux disease (GERD); malnutrition; multidisciplinary care; neurological.

Grants and funding

This study was supported by Danone Nutricia S.p.A Society Benefit with a voluntary and unconditional contribution to research on nutrition field of Bambino Gesù Children Hospital. Danone Nutricia S.p.A had no role in the design, conduct, and realization of the study.