S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der Gesellschaft für klinische Ernährung der Schweiz (GESKES), der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE), die Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ) und die Gesellschaft für Neonatologie und pädiatrische Intensivmedizin (GNPI)

Zusammenfassung

Eine besondere Herausforderung bei der Durchführung parenteraler Ernährung (PE) bei pädiatrischen Patienten ergibt sich aus der großen Spannbreite der Physiologie und Physiognomie von Säuglingen, Kleinkindern, Kindern und Jugendlichen, die von extrem unreifen Frühgeborenen bis hin zu Jugendlichen mit einem Körpergewicht von mehr als 100 kg reicht, und dem jeweils unterschiedlichen Substratbedarf. Dabei sind alters- und reifeabhängige Veränderungen des Stoffwechsels sowie des Flüssigkeits- und Nährstoffbedarfs zu berücksichtigen sowie auch die klinische Situation, in der eine PE eingesetzt wird. Das Vorgehen unterscheidet sich deshalb ganz erheblich von der PE-Praxis bei erwachsenen Patienten, z. B. ist der Flüssigkeits-, Nährstoff- und Energiebedarf von Früh- und Neugeborenen pro kg Körpergewicht weitaus höher als bei älteren pädiatrischen und erwachsenen Patienten. In der Regel benötigen alle Frühgeborenen < 35 SSW und alle kranken Reifgeborenen (angepasst an Erkrankung und Klinik) während der Phase des allmählichen Aufbaus der oralen und enteralen Nahrungszufuhr eine vollständige oder partielle PE. Die Zufuhrmengen der PE bei Neonaten müssen berechnet (nicht geschätzt) werden. Der Anteil der PE sollte zur Minimierung von Nebenwirkungen sobald wie möglich durch Einführung einer enteralen Ernährung vermindert (teilparenterale Ernährung) und schließlich komplett durch enterale Ernährung abgelöst werden. Eine unangemessene Substratzufuhr im frühen Säuglingsalter kann langfristig nachteilige Auswirkungen im Sinne einer metabolischen Programmierung des Krankheitsrisikos im späteren Lebensalter haben. Wenn bei älteren Kindern und Jugendlichen die enterale Energie- und Nährstoffzufuhr nicht bedarfsgerecht möglich ist, sollte abhängig von Ernährungszustand und klinischen Umständen spätestens innerhalb von 7 Tagen eine partielle oder totale PE erwogen werden.

Abstract

Implementing parenteral nutrition (PN) in paediatric patients poses special challenges, which arise from the wide range of patients’ conditions, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. In addition age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration, along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN practice in adult patients, e. g. the fluid, nutrient and energy intake of premature infants and newborns per kg body weight is higher than that of older paediatric and adult patients. All premature infants < 35 weeks of pregnancy and most ill term infants require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. In school-aged children and adolescents who achieve an oral or enteral intake that however does not approach their energy and nutrient demands, partial or total PN should be considered no later than after 7 days, taking into account nutritional status and clinical conditions.

Schlüsselwörter

Frühgeborenes - Säugling mit niedrigem Geburtsgewicht - Neugeborenes - Monitoring - Kindheit

Keywords

premature infant - low birth weight infant - newborn infant - monitoring - childhood

^* DGEM Steering Committee: Bischoff SC, Lochs H, Weimann A sowie das DGEM-Präsidium

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