Risks and Complications of Enteral Feeding

Complications of enteral feeding are dependent on the type and route of feeding. See Table 17 .

Refeeding syndrome can be an early complication of initiating enteral feeds in malnourished patients or those with severely restricted oral intake. Prevention requires identification of children at risk (Alberta Health Services, 2013), measuring and correcting electrolyte abnormalities before initiating nutrition support, and increasing nutrient delivery slowly. Children at risk include those with chronic malnutrition, no intake for seven to ten days, weight loss of ten per cent within two to three months, below 70 per cent ideal body weight, intake < 50% requirements for more than 14 days, pre-existing electrolyte disturbances (particularly low phosphate), and prolonged gastrointestinal malabsorption (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015).  There is also a risk of overfeeding malnourished children who have had malnutrition but have low energy needs. 

Metabolic consequences of refeeding syndrome include hypophosphatemia, hypokalemia, and hypomagnesaemia and can lead to severe medical complications including muscle weakness, impaired cardiac and respiratory function leading to fluid overload, cardiac arrhythmia, and possible death (Khan, Ahmed, Khan, & MacFie, 2011). Monitoring for signs of refeeding syndrome in children at risk is recommended one to four times per day for the first three days and daily thereafter for the first two weeks of feeding (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015). Electrolyte repletion (per guidelines) is needed when abnormalities are identified.

Refer to: ASPEN Pediatric Nutrition Support Core Curriculum – Refeeding Management Guidelines, p 543

Enteral formulas are formulated to provide adequate amounts of micronutrients to meet age-related energy requirements. As such, children with low volume feeds or low energy feeds, e.g. those with neurological impairment, may be at higher risk of micronutrient deficiency. Micronutrient supplementation and additional monitoring may be required to optimize nutrient intakes (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015).