Pediatric enteral nutrition after hospital discharge: A systematic review and toolbox for clinical practice

Background & aim: 

Post-discharge of any hospitalization nutritional care for children is a common practice, with approximately 3,000 children in the Netherlands receiving medical enteral nutrition upon discharge each year. Despite its prevalence, little insight is available about the duration and outcomes of prolonged nutritional care. This systematic review aims to assess existing evidence regarding post-discharge nutritional care, and its impact on various outcome parameters including growth, body composition, nutritional status, eating behavior, Quality of Life (QoL) for both child and parent, parental stress, and cost-effectiveness. 

Methods: 

A comprehensive search was conducted up to February ‘25 across multiple databases including Cochrane, MEDLINE, CINAHL, Web of Science, and Embase. Observational and randomized studies involving children (from term-born neonates to 18 years old) in high-income countries receiving nutritional care (oral and/or enteral) requiring follow-up after discharge were included. 

Results: 

Eleven studies were included, three of which employed randomized designs. Eight studies described newborns and infants suffering from congenital heart disease, with follow-up durations ranging from two weeks to two years. Enteral nutrition interventions primarily targeted parental education and structured follow-up plans. All studies reported an increase in weight-for-age z-scores (WAZ) from baseline, with improvements ranging from 0.4 to 0.8. The most substantial WAZ gains were observed in interventions involving a combined intervention, e.g. a multidisciplinary follow-up plan combined with the use of telehealth. Despite the broad range of follow-up periods, key outcome measures such as body composition, eating behavior, QoL, parental stress, and cost-effectiveness remained underexplored. 

Conclusions: 

Studies on post-discharge enteral nutritional interventions in children suggest an overall positive impact on weight-for-age z scores, with the most notable improvements observed in multifaceted approaches combining structured nutritional programs with parental guidance. Based on the available evidence, a practical ‘toolbox’ advice derived of recommendations is developed to support dieticians and clinicians in delivering structured and guided nutritional care following hospital discharge.