Pediatride Nazogastrik Beslenme ve Yönetimi
Özet
Bu kitap bölümünün amacı, pediatrik hastalarda nazogastrik yolla enteral beslenmenin kanıta dayalı ilkelerini, uygulama basamaklarını ve sık karşılaşılan sorunların yönetimini özetlemektir. Çocukluk çağında malnütrisyon, kronik hastalıklar, nörolojik yetersizlikler ve kritik hastalıklar nedeniyle sık görülmekte; gastrointestinal sistem fonksiyonel olduğunda nazogastrik tüp ile enteral beslenme, parenteral beslenmeye göre tercih edilen bir yöntem hâline gelmektedir. Bölümde öncelikle nazogastrik beslenmenin endikasyon ve kontrendikasyonları, tüp seçimi ve yerleştirme teknikleri, yer doğrulama yöntemleri ile aralıklı ve sürekli beslenme yaklaşımları ele alınmaktadır. Ardından beslenme toleransının değerlendirilmesi, mekanik ve gastrointestinal komplikasyonların önlenmesi ve yönetimi, evde enteral beslenme ve aile eğitimi konuları tartışılmaktadır. Son olarak nazogastrik yolla ilaç uygulamasında dikkat edilmesi gereken noktalar ve nörolojik disfonksiyon, cerrahi sonrası dönem ve yüksek aspirasyon riski gibi özel klinik durumlar gözden geçirilmektedir. Bu bütüncül yaklaşımın, pediatride nazogastrik beslenmenin güvenli ve etkin bir şekilde planlanmasına katkı sağlayacağı düşünülmektedir.
The aim of this book chapter is to summarize the evidence-based principles, practical steps and management of common problems related to nasogastric enteral nutrition in pediatric patients. Malnutrition is frequently encountered in childhood due to chronic diseases, neurological impairments and critical illness; when the gastrointestinal tract is functional, nasogastric tube feeding becomes the preferred option over parenteral nutrition. The chapter first addresses the indications and contraindications of nasogastric feeding, tube selection and insertion techniques, methods for verifying tube position, and the comparison of intermittent and continuous feeding strategies. It then discusses the assessment of feeding tolerance, prevention and management of mechanical and gastrointestinal complications, home enteral nutrition and family education. Finally, key considerations for drug administration via nasogastric tube and special clinical situations such as neurological dysfunction, postoperative period and high aspiration risk are reviewed. This comprehensive approach is expected to support the safe and effective planning of nasogastric feeding in pediatric practice.
Referanslar
Ağın, H. (2011). Nutrition in critically ill patients. Turkiye Klinikleri J Pediatr Sci, 7(1), 73-80.
Aközlü, Z., & Mutlu, B. (2024). Çocuklarda enteral beslenme ve hemşirelik bakımı. Ankara Sağlık Bilimleri Dergisi, 13(2), 181–196. https://doi.org/10.46971/ausbid.1415376
Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., Metheny, N. A., Mueller, C., Robbins, S., Wessel, J., & A.S.P.E.N. Board of Directors (2009). Enteral nutrition practice recommendations. JPEN. Journal of parenteral and enteral nutrition, 33(2), 122–167.
https://doi.org/10.1177/0148607108330314
Braegger, C., Decsi, T., Dias, J. A., Hartman, C., Kolacek, S., Koletzko, B., … ESPGHAN Committee on Nutrition. (2010). Practical approach to paediatric enteral nutrition: A comment by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 51(1), 110–122. https://doi.org/10.1097/MPG.0b013e3181d336d2
Chau, J.P.C., Liu, X., Choi, K.C., Lo, S.H.S., Lam, S.K.Y., Chan, K.M., et al. (2021). Diagnostic accuracy of end-tidal carbon dioxide detection in determining correct placement of nasogastric tube: An updated systematic review with meta-analysis. International Journal of Nursing Studies, 123, 104071.
Druyan, ME., Compher, C., Boullata, JI, et al. (2012). Clinical guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients: applying the GRADE system to development of A.S.P.E.N. clinical guidelines. J Parenter Enteral Nutr, 36,77-80.
Hamilton, S., McAleer, D., Ariagno, K., Barrett, M., Stenquist, N., Duggan, C. P., & Mehta, N. M. (2014). A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 15(7), 583.
Heuschkel, R.B., Gottrand, F., Devarajan, K., Poole, H., Callan, J., Dias, J.A., et al. (2015). ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. Journal of pediatric gastroenterology and nutrition, 60(1), 131-141.
Irving, S. Y., Lyman, B., Northington, L., Bartlett, J. A., Kemper, C., & NOVEL Project Work Group. (2014). Nasogastric tube placement and verification in children: Review of the current literature. Critical Care Nurse, 34(3), 67–78. https://doi.org/10.4037/ccn2014606
Kabaçam, G., & Özden, A. (2009). Enteral tüple beslenme. Güncel Gastroenteroloji, 13(4), 201-210.
Kendirli, T. (2011). Kritik çocuk hastada beslenme. Klinik gelişim, 24, 34-43.
Killian, M., Reeve, NE., Slivinski, A., & Bradford, JG. (2019). Clinical Practice Guideline: Gastric Tube Placement Verification In patients having gastric tubes inserted in the emergency department setting, which bedside technique is best for confirmation of accurate placement immediately after tube insertion compare. J Emerg Nurs., 45(3),306.
Kültürsay, N., Bilgen, H. ve Türkyılmaz, C. (2014). Prematüre ve hasta term bebeğin beslenmesi rehberi. Türk Neonatoloji Derneği.
Lin, T., Gifford, W., Lan, Y., et al. (2017). Diagnostic accuracy of ultrasonography for detecting nasogastric tube (NGT) placement in adults: A systematic review and meta analysis. Int J Nurs Stud. 71,80-88. doi:10.1016/j.ijnurstu.2017.03.005
Mak, M.Y., & Tam, G. (2020). Ultrasonography for nasogastric tube placement verification: An additional reference. Br J Community Nurs., 25(7),328-334. doi:10.12968/bjcn.2020.25.7.328
Martinez, E. E., Bechard, L. J., Brown, A.-M., Coss-Bu, J. A., Kudchadkar, S. R., Mikhailov, T. A., … Mehta, N. M. (2022). Intermittent versus continuous enteral nutrition in critically ill children: A pre-planned secondary analysis of an international prospective cohort study. Clinical Nutrition, 41(12), 2621–2627. https://doi.org/10.1016/j.clnu.2022.09.018
Mehta, N. M., Skillman, H. E., Irving, S. Y., Coss-Bu, J. A., Vermilyea, S., Farrington, E. A., … Braunschweig, C. (2017). Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 41(5), 706–742. https://doi.org/10.1177/0148607117711387
Mordiffi, SZ., Goh, ML., Phua, J., Chan, YH. (2016). Confirming nasogastric tube placement: Is the colorimeter as sensitive and specific as X-ray? A diagnostic accuracy study. Int J Nurs Stud., 61,248-257. doi:10.1016/j.ijnurstu.2016.06.011
Premji, S. S., & Chessell, L. (2011). Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams. Cochrane Database of Systematic Reviews, 2011(11), CD001819. https://doi.org/10.1002/14651858.CD001819.pub2
Tume, L.N., & Valla, F. V. (2018). A review of feeding intolerance in critically ill children. European journal of pediatrics, 177, 1675-1683.
Tume, L. N., Valla, F. V., Joosten, K., Jotterand Chaparro, C., Latten, L., Marino, L. V., … Verbruggen, S. C. A. T. (2020). Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Medicine, 46(3), 411–425. https://doi.org/10.1007/s00134-019-05922-5
Vermilyea, S., & Goh, V. L. (2016). Enteral feedings in children—Sorting out tubes, buttons, and formulas. Nutrition in Clinical Practice, 31(1), 59–67. https://doi.org/10.1177/0884533615604806
Volpe, A., & Malakounides, G. (2018). Feeding tubes in children. Current Opinion in Pediatrics, 30(5), 665–671. https://doi.org/10.1097/MOP.0000000000000666
White, J.V., Guenter, P., Jensen, G., Malone, A., Schofield, M., Force, A. M. T., & Academy Malnutrition Work Group. (2012). Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). Journal of the Academy of Nutrition and Dietetics, 112(5), 730-738.
Yakut, T., Sönmez Düzkaya, D., & Uysal, G. (2025). Evaluation of enteral nutrition applications in pediatric intensive care units in Türkiye. Turkish Journal of Intensive Care, 23(1), 78–87. https://doi.org/10.4274/tybd.galenos.2024.26214
Yi, D. Y. (2018). Enteral nutrition in pediatric patients. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 12–19. https://doi.org/10.5223/pghn.2018.21.1.12
