1 報告學生 : 劉家祥 指導老師 : 賴聖如 營養師 報告日期 : 2012/12/28

2 Effect of early enteral nutrition on morbidity and mortality in children with burns. burns 36 ( 2010 ) 1067 – 1071

3 The burn can result in profound metabolic abnormalities, and that malnourishment is associated with increased infection risks, decreased healing rates and altered cell function. auto-destructive

4 International nutritional support guidelines concur that enteral feeding should occur early in critically ill patients who have a functioning gastrointestinal tract but time frames as to what is considered early varies from 24 to 48 h. J Physiol 1993;119:210–23.

5 30days- 12Y/O 2 h prior to admission ≧10% TBSA

6 LEN enteral nutrition after 48 h kept open with 5 ml h -1 EEN within 3–6 h every 3 h by 50% (2 ml kg - 1 ), 33% (3ml kg -1 ),25% (4 ml kg -1 ),20% (5 ml kg -1 ) and 17% (6 ml kg -1 )

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8 17–20% of protein 22–28% of fat 55–58% of carbohydrate

9 The LEN group lost 9% of body weight between admission and discharge compared to 3% in the EEN group.

10  Our research showed that EEN decreases duration of hospitalisation and mortality in children with burns.

11 Nutrition 28 (2012) 864–867

12 infectious complications mortality

13 Literature search MEDLINEEMBASE

14 Objective criteria of critical illness. (1) The patients were recruited in an ICU or (2) The inclusion criteria described were such that the patients would normally be cared for in an ICU (e.g. all patients were receiving invasive mechanical ventilatory support) or (3) The patients were suffering from a condition that usually requires care in an ICU (e.g. severe thermal burns of >40–50% TBSA, multi trauma that required urgent laparotomy) or (4) The patients had an average ICU length of stay of greater than two days or

15 Fig. 1. Flow diagram

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17 Multiple organ dysfunction syndrome (MODS) 12/17 EN patients 2.5 ± /19 EN patients 3.1 ± 0.8 （ organ failures per patient ） Pneumonia EN within 24 h of injury incidence of pneumonia

18 Although the detection of a statistically significant reduction in mortality is promising,overall trial quality was low and trial size was small. The results of this meta-analysis should beconfirmed by the conduct of a large multi-center trial.

19 Factors leading to discrepancies between prescription and intake of enteral nutrition therapy in hospitalized patients

20 The prescribed amount of ENT to be provided via feeding tube or stoma is not always actually delivered to the patient.

21 Methods and results

22 A total of 640 patients older than 18 Y/O,TF,gastrostomies,jejunsotomies enrolled 201 patients Patient identification variables excluded from discharged from the hospital, died, oral or parenteral nutrition. cardiac diseases infectious diseases. neurologic diseases cancer vascular diseases ENT included 45 patients ENTand 4 patients data records.

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25 In this study, the major reasons for the discrepancy between EN prescription and intake in a general Brazilian hospital were operational logistical problems, gastric stasis, accidental loss of enteral feeding tube, and interference by an external physician.

26 早期腸道營養可以降低燒燙傷孩童的死亡率以及住院 時間，對於創傷的病人則是可以降低住院感染率以 及死亡率。由前兩個文得知及早的腸道營養對於病 人的重要性，但是在給予病人腸道營養時 ( 非由口進 食 ) ，需注意某些因子阻礙了營養的攝取。

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