Enteral tube feeding improves growth in children with CKD even after 2 years of age
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A published study found starting enteral tube feeding after 2 years of age improved height and weight standard deviation score in pre-pubertal children with CKD stages 2 to 5.
“Poor growth is a recognized complication of chronic kidney disease across all stages but is especially notable in CKD stage 5, both before and on dialysis,” Matko Marlais, BSc, MBBS, MSc, consultant pediatric nephrologist at Great Ormond Street Hospital for Children NHS Foundation Trust, and colleagues wrote. “Infants and children less than 2 years of age are particularly at risk as adequate nutrition, which can be difficult to maintain, is the main determinant of growth at this age ... While there is good evidence that enteral tube feeding during the first 2 years of life improves both weight [standard deviation score] SDS and height SDS in children with CKD, the evidence of any benefits over this age is conflicting.”
To determine if enteral tube feeding started after the age of 2 years improves growth, researchers conducted a retrospective study of 50 children aged between 2 and 11 years (median age at start of tube feeds, 5.6 years; 34 children not yet on dialysis; 15 children on PD). They considered height, weight and BMI 1 year before tube feeds began, at the start, and after 1 year and 2 years.
After 1 year of enteral tube feeding, researchers observed overall height SDS improved from -2.39 to -2.27 and, after 2 years, height improved to -2.18. Researchers noted the most significant improvements in height SDS were seen in children aged between 2 and 6 years and those who were not on dialysis. BMI also improved after 1 year (from -0.72 to 0.23) and 2 years (0.09). Furthermore, there was no evidence of excessive weight gain as BMI SDS remained stable in the second year.
“[O]ur study is the largest cohort to date assessing the impact of enteral tube feeding in older children with CKD,” the researchers wrote. “ ... children starting enteral feeds after 2 years of age are still relatively uncommon (as a proportion of all children with CKD). A prospective study of this nature would therefore take a very long time and is unlikely to be feasible ... We suggest that pediatric nephrologists and dieticians should consider enteral tube feeding in all children with CKD, particularly in children who have a lower than average BMI and children under the age of 6 years when significant improvements in height may be achieved.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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