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Andrew B. Kairalla MD, Editor
Reviewed by: Mindy Morris RN
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Nutrition for ECMO
A.S.P.E.N. Clinical guidelines: nutrition support of neonates supported with
extracorporeal membrane oxygenation. Jaksic T,Hull MA,Modi BP,Ching YA, George
D, Compher C; American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board
of Directors. Children's
Hospital Boston, Harvard Medical School, Boston, MA, USA. JPEN J Parenteral
Enteral Nutr, 2010, May-Jun;34(3):247-53.
Link to site via pubmed
here
The authors note that “ECMO does not provide a metabolic rest." The neonate on ECMO has a high rate of protein catabolism and very limited nutritional reserves. “The purpose of this Clinical Guideline is to address the nutrition support of neonatal patients treated with ECMO. The Clinical Guidelines were created in accordance with the Institute of Medicine recommendations for systematically developed statements and were written to enable the end user to understand the strength of the literature and level of evidence to grade each recommendation”.
There are four Guideline recommendations for nutrition support in Neonates on ECMO: 1) Nutrition support should be initiated expeditiously 2) Protein requirements up to 3gram/kg/day 3) Energy requirements are equivalent to healthy subjects, and 4) Enteral feedings should be initiated when the patient has clinically stabilized.
Comments: The American Society for Parenteral and Enteral
Nutrition (A.S.P.E.N) is an organization compromised of healthcare professionals
and as a Society has a mission to improve patient care by advancing the science
and practice of nutrition support therapy. They have published several clinical
guidelines such as: Nutrition Support of the Critically Ill Child (here).
The A.S.P.E.N. Board of Directors has been publishing Clinical Guidelines since
the 1980’s and this guideline was released May 2010. Most of the evidence
supporting these recommendations is Level III, which is understandable in such a
small specific population base. One of the recommendations is for enteral
feedings as soon as the patient is clinically stable – this is very open for
interpretation. Many centers have developed feeding guidelines for the preterm
infant, has anyone implemented a guideline for feeding the patient on ECMO?
Please share your comments.
Sue Freck, RD, CSP, CNSC and Mindy Morris
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