Preoperative Nutritional Support in Children with End-Stage Liver-Disease Accepted for Liver-Transplantation - An Approach to Management

Pre‐operative nutritional support was studied in 28 children with end‐stage liver disease awaiting orthotopic liver transplantation. Nasogastric supplemental administration of a standard semi‐elemental enteral nutritional formula was compared with a similar formula enriched with branched chain amino acids, and with a group receiving oral nutrition only. The duration of treatment in all groups was similar (mean 90 days). Energy intakes in the supplemented groups were 120–150% of recommended daily intakes (RDI), whereas ad libitum intakes in the oral group ranged 58–100% RDI. A significant improvement in mean Z‐score for body weight (denoting catch‐up) was noted only in those children who received nasogastric supplements enriched with branched‐chain amino acids. The standard enterally‐fed group maintained their body weight and Z‐scores did not change significantly. In contrast, body weight Z‐scores in those fed orally declined significantly. Nutritional supportive therapy of malnourished children with end‐stage liver disease can minimize or improve nutritional status in children awaiting liver transplantation. The use of nutritional formulae rich in branched‐chain amino acids may have nutritional advantages in children with chronic liver disease which require further study and evaluation