A recent position paper (IJ Borekaert et al. JPGN 2019; 69: 239-58) makes 33 recommendations on the use of jejunal tube feedings.
Full Text Link: The Use of Jejunal Tube Feeding in Children: A Position Paper by the Gastroenterology and Nutrition Committees of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition 2019.
Here are a few of the recommendations:
- #1 Jejunal feeding is route of choice for enteral nutrition with failure of oral and intragastric feeds or gastric outlet obstruction
- #5 Expert group recommends the use of jejunal feeding in children with acute pancreatitis only in cases in which oral or gastric feeding is not tolerated
- #6 Recommends trial of continuous gastric feeds or a hydrolyzed or elemental formula prior to jejunal feedings
- #8 & 9 Expert group recommends to consider UGI/SBFT and an upper GI endoscopy in all patients before jejunal tube placement
- #12 Recommends NOT to use jejunal tube feedings in preterm infants (<37 weeks gestation). This is based on systemic reviews including Cochrane review which concluded “that there is no evidence of any benefit for transpyloric feeding in preterm infants compared to gastric feeding”
- #21 Recommends monitoring for nutrient deficiencies –checking copper, zinc, selenium, and iron every 6-12 months (Low level of evidence). The authors note that some studies have shown reductions in these nutrients; this may be related in part to be due to bypassing the duodenum
- #24 Avoiding using jejunal tube for medication unless absolutely essential or delivery into the stomach is not possible