nutrition support in the paediatric surgical patient
DESCRIPTION
Outline Introduction/Background Conditions seen in MNU needing Surgical Interventions Nutritional Rehabilitation in MNU Role of the Paediatric Surgeons and Paediatricians ConclusionTRANSCRIPT
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Dr. Mariama MustaphaSHO III- Paediatrics and Child Health
Makerere UniversityMwanamugimu Nutrition Unit, Mulago Hospital
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OutlineIntroduction/Background
Conditions seen in MNU needing Surgical Interventions
Nutritional Rehabilitation in MNU
Role of the Paediatric Surgeons and Paediatricians
Conclusion
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Introduction/BackgroundThe WHO defines malnutrition as “the imbalance
between the supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specific functions”.
It is estimated that 34 million children under the age of 5 each year are affected by severe acute malnutrition (SAM).
UNICEF 2012
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Background: Uganda DHS 2011
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BackgroundWork by Cooper and colleagues showed that
18% to 40% of paediatric surgical patients have malnutrition.
Paediatric surgical patients respond to surgical stress differently from older children or adults.
The metabolism of children is markedly affected by operative stress.
Herman R et al, 2011.
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Conditions seen in MNU needing Surgical Interventions
Cerebral Palsy
Congenital Heart Diseases
Massive Pleural Effusion/Empyema
Cleft Lip/Palate
Burns
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Conditions seen in MNU needing Surgical Interventions
Hydrocephalus
Pyloric Stenosis
Hirschsprung’s Disease
Oesophageal Stricture
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Summary of Nutritional Assessment and Classification
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Nutritional Rehabilitation: Outpatient Therapeutic Care (OTC)
Admission CriteriaChildren with SAM who have appetite, are
clinically well and alert and have oedema grade +/++
For MAM with HIV or TB
Transfers in
Relapse or readmission
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Nutritional Rehabilitation: OTCDietary Therapy
Ready-to-Use Therapeutic Food (RUTF):Contains 500 kcal per 92gNeed calculated based on
175-200kcal/kg/day
Breastfeeding on demand.
Adequate safe drinking water while on RUTF.
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Nutritional Rehabilitation: Inpatient Therapeutic Care (ITC)
Admission CriteriaChildren with Severe Acute Malnutrition with:
Medical complications
Severe 0edema (+++)
Poor appetite
IMCI danger signs
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Nutritional Rehabilitation: ITCDietary Therapy
F-75
F-100
RUTF
SDTM
Isomil
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Preoperative NutritionIn malnourished adults, provision of enteral
feedings preoperatively for 2 to 3 weeks may reduce:Postop wound infections
Anastomotic leakage
Hepatic and renal failure
Length of hospital stay
Data for PN support are less clear!Herman R et al, 2011
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Postoperative NutritionWhen used, postop nutrition should be started
early using a combination of PN and EN until the GIT fully recovers.
In the postop period, there are higher infection rates in patients on PN.
Postop PN should be restricted to:Infants who do not tolerate enteral feedings.Older children who probably cannot tolerate EN for
at least 5 to 7 days.Herman R et
al, 2011
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How Can We Work Together?Role of the Paediatric Surgeons?
Identify patients needing nutritional interventions
Consult/Refer
Role of the Paediatricians?Identify patients needing surgical
interventionsConsult/Refer
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ConclusionMaintaining adequate nutrition of paediatric
surgical patients is critical.
Close follow-up is critical to maintain a child on target for growth objectives.
Paediatric Surgeons and Paediatricians need to work together to provide optimal nutrition support to paediatric surgical patients.
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