PAEDIASURE COMPACT / PAEDIASURE PLUS FIBRE CASE STUDY: SPINAL CORD INJURY
Jay’s healthcare professional: Dietitian for Paediatrics and Adults, Royal National Orthopaedic Hospital
MEDICAL AND NUTRITIONAL HISTORY
Jay is a 14-year-old male who sustained a traumatic spinal cord injury, following an accidental fall in a school playground, where another child fell on him. Initially getting up and walking away from the incident, he collapsed 24 hours later and was admitted to hospital.
The injury had restricted blood flow to the spinal cord. Jay was now tetraplegic (C3 ASI C incomplete spinal cord injury) and unable to breathe without full use of a ventilator, he had a tracheostomy and relied entirely on nasogastric feeding to meet his nutrition and hydration needs. The nasogastric tube was adding to the challenges of managing his secretions, and after one month this was replaced by a percutaneous endoscopic gastrostomy (PEG). Jay was transferred to the Royal National Orthopaedic Hospital, a tertiary centre offering specialist spinal rehabilitation.
Prior to the accident, Jay was a healthy, athletic young person, tall for his age measuring 1.88 m in height. An avid swimmer, he had a muscular build and a weight of 75 kg.
NUTRITIONAL TREATMENT
By the time he arrived for rehabilitation, Jay had experienced significant weight loss post-injury, with a body weight of 48.5 kg. Initial rehabilitation goals were to attempt to wean him off the ventilator, and regain body weight. Jay experienced intense neuropathic pain so severe that sedation was required to handle the PEG tube.
Jay’s Dietitian started him on PaediaSure Plus Fibre upon arrival, with six daytime bolus feeds, which he tolerated very well. His body size might have indicated the use of an adult feed however the protein level was potentially excessive and was found previously to adversely affect his kidney function. He was transitioned to a continuous feeding regime of PaediaSure Plus Fibre overnight, in combination with two PaediaSure Compact* boluses during the day, adding a further 600 kcal/day to support recovery. PaediaSure Compact was selected due to its low-volume presentation which reduced pressure from the stomach on Jay’s lungs, supporting respiratory weaning. Jay tolerated his enteral feeding regime well.
Once weaned off the ventilator when Jay was able to swallow safely, oral feeding was introduced at IDDSI 6 texture-modified diet. PaediaSure Compact was delivered via the PEG tube to support his nutrition while being established on food. Re-establishing a fully oral diet and allowing all textures and free fluids took over a month - being limited by fatigue and an overall low psychological status.
As Jay’s abdominal sensitivity and neuropathic pain were negatively impacting and decelerating rehabilitation potential, the decision was made to remove the PEG prematurely. This created a notable psychological improvement, pain (both physical and psychological in origin) diminished, which allowed hoisting and acceptance of the wheelchair.
The high-fibre content of PaediaSure Plus Fibre helped to optimise Jay’s bowel management. Once the PEG tube was removed, he was reliant on oral intake to meet his nutritional and hydration needs. While having PaediaSure Compact, no supplementary vitamins and minerals were required.
OUTCOMES
6 months after his accident, Jay was enjoying eating and drinking normally, breathing unsupported day and night, able to use a powered wheelchair and manipulate a computer screen unaided. He was discharged home and started reintegrating back into his former mainstream school. Jay had successfully regained weight to an ideal 71.6 kg, and his pressure sores had healed.
KEY FINDINGS
- The psychological impact of Jay’s injury and the intense neuropathic pain he experienced affected not only Jay and his family but also the MDT working with and around him. The MDT had to carefully manage the emotional state of both Jay and his family throughout his care.
- While anthropometric measurements may indicate the use of adult nutritional supplements for young people of a certain size, the individual’s specific macro- and micronutrient requirements need to be considered. For example, an excess of protein may have had an adverse effect on renal function.
- Jay tolerated his PaediaSure feeding regime well and had a positive response to high feeding rates, which enabled time for the MDT to deliver all of his daily care needs.
READ THE FULL CASE STUDY
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Footnotes:
*The PaediaSure range is for ages 1-10 years or children weighing 8-30kg. The use of PaediaSure medical nutrition products outside of these ranges is under the supervision of the healthcare professional and their clinical judgement.
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