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Entwöhnung von langfristiger Sondenernährung

Weaning from long-term tube dependency

  • Leitthema
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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Junge Kinder mit einer umfassenden Krankengeschichte (z. B. Frühgeburt, komplexe Operationen oder Krankheiten) haben häufig Fütterungsstörungen und werden über eine Sonde ernährt. Die Sondenernährung stellt eine effektive und wichtige Behandlung zur Prävention einer Malnutrition dar. Sie reduziert jedoch auch die Motivation des Kindes, selbstständig zu essen, und kann zur Aversion gegen orale Nahrungszufuhr führen.

Ziel der Arbeit

Der vorliegende Beitrag geht der Frage nach, wie erfolgreich die klinische Hungerprovokation bei jungen Kindern mit Langzeitsondierung ist.

Material und Methode

In einer Cross-over-Studie wurden 22 Kinder (Alter 11 bis 26 Monate) mit Langzeitsondierung in 2 Gruppen randomisiert: Gruppe A (Intervention) wurde mithilfe eines 2-wöchigen multidisziplinären Hungerprovokationsprogramms behandelt, und Gruppe B (Kontrolle) wurde 4 Wochen lang durch dasselbe Team poliklinisch behandelt. Bei erfolgloser Therapie fand ein Cross-over zur anderen Therapieform statt.

Ergebnisse

Innerhalb von 2 Wochen wurden 9 der 11 Patienten in der Gruppe A erfolgreich sondenentwöhnt. (Ein Patient entwickelte eine Colitis ulcerosa; bei einem Patienten wurde die Behandlung auf Wunsch der Eltern beendet.) Dagegen konnte nur ein Patient aus Gruppe B erfolgreich entwöhnt werden. Die anderen 10 Patienten wechselten anschließend ins Hungerprovokationsprogramm; im Rahmen dieses Programms konnte die Sondenernährung bei sämtlichen dieser Patienten erfolgreich auf orale Nahrungszufuhr umgestellt werden. Sechs Monate nach der Therapie waren 20/21 Patienten noch immer vollständig entwöhnt, bei einem Patienten war die Sondenernährung noch teilweise notwendig. Zusammengefasst wurden in Gruppe B 1/11 (9 %) der Patienten erfolgreich entwöhnt, verglichen mit 18/21 (86 %) der Patienten in Gruppe A (p < 0,001).

Schlussfolgerungen

Die multidisziplinäre klinische Hungerprovokation stellt eine sehr erfolgreiche schnelle Behandlung bei langzeitig sondierten jungen Kindern dar.

Abstract

Background

Young children with a complex medical history frequently develop feeding problems. Although tube feeding is effective in providing the necessary energy and nutrients, it decreases the child’s motivation to eat and may lead to aversion to oral feeding.

Objectives

The aim of this study was to confirm the results of a previous study showing that a multidisciplinary clinical hunger provocation program for children may lead to quick resumption of oral feeding after long-term tube feeding.

Material and methods

In a cross-over study 22 young children who were fully dependent on tube feeding were randomly assigned to 1 of 2 groups: group A (intervention group) which followed a 2-week multidisciplinary clinical hunger provocation program and group B (control group) which followed a 4-week outpatient treatment by the same multidisciplinary team. When one treatment was unsuccessful patients were reassigned to the other treatment group. Primary outcome measures were at least 75 % orally fed at conclusion of the intervention and fully orally fed and gaining weight 6 months after the intervention.

Results

In the hunger provocation group 9 out of 11 patients were successfully weaned from tube feeding (2 failures: 1 developed ulcerative colitis and 1 dropped out at the request of the parents). In the control group only 1 patient was successfully weaned and 10 out of the 11 children were reassigned to the hunger provocation program, all being successfully weaned. At 6 months after the intervention 1 patient had to resume tube feeding. In total 1 patient out of 11 (9 %) in the control group was successfully weaned as compared to 18 out of 21 (86 %) in the hunger provocation group (p < 0.001).

Conclusion

Multidisciplinary clinical hunger provocation is an effective short-term intervention for weaning young children from tube feeding.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Kindermann gibt an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Emma Children’s Hospital, Academic Medical Center, H7–250, Meibergdreef 9, 1100, Amsterdam, Niederlande

    A. Kindermann

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Kindermann, A. Entwöhnung von langfristiger Sondenernährung. Monatsschr Kinderheilkd 164, 31–36 (2016). https://doi.org/10.1007/s00112-015-3433-5

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  • DOI: https://doi.org/10.1007/s00112-015-3433-5

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