Constant flow enteral feeding with an elemental diet in the treatment of severe protracted diarrhea in early childhood

: The enteric nutrition with constant flow (ENCF) with elemental and semielemental diets is a very useful therapeutic approach in the management of severe and protracted diarrhoea in young infants. It can be proceeded or not by a period of total parenteral nutrition according to age of the patient, the entity and duration of the diarrhoea and the degree of the malnutrition and the presence or not of an infection. The indication of the enteric alimentation with a constant flow has been done in cases of severe diarrhea prolonged more than 14 days without response to the traditional dietetic treatment and/or a state of malnutrition with weight - 2 SD with respect to the average of the age/height ratio and/or a plasma proteins less than or equal to 4.5 g% and an albuminemia less than 2.8 g%. The casuistry is made up of 19 cases, from the age of 1 month to 20 month. The duration of the treatment was between 13 and 123 days. The enteric alimentation was done with elemental or semielemental diet with an osmolarity of 320 m OSM/C. freshly preparated; each of the ingredients could be modified independently one from the other. The decision to modify qualitatively and quantitatively the diet is always the consequence of a daily evaluation of the nutritional needs of the child and at the same time of the digestive tolerance valued according to precise clinical and biological criteria. The results obtained were: arrest of diarrhoea in 90% of the cases (17/19), continuation of diarrhoea in 10% (2/19) and death in 1 case. The weight increase was obtained in 90% of the cases (M = 13.2 gr./die). The Authors discuss the criteria to decide 1) if a period of TPN had to proceed the ENCF, 2) the more adapt components to utilize for elemental and semielemental diet, 3) the modality of practial realization, 4) the criteria of clinical and biological supervision, 5) the possible mechanical and metabolical complications. The Authors conclude that the ENCF with elemental and semielemental diets is an important progress in the therapeutic approach in serious and protracted diarrhoea in young infants. The knowledge of the problem, a careful clinical and biological supervision are the best methods to obtain the maximum and the minimum risks of mechanical and metabolical complications.