Progress of enteral feeding practice over time: moving from energy supply to patient- and disease-adapted formulations.

Enteral nutrition comprises the delivery of a liquid formula beyond the esophagus via a feeding tube in a patient with insufficient oral intake, as well as the provision of specialized nutritional formula irrespective of the route of delivery. Pediatric formulae have been designed for different age groups, and for children with certain diseases; examples are special formulations for regurgitating infants, metabolic diseases, cow's milk or multiple food allergies, intestinal, pancreatic, renal, and hepatic insufficiency. Exclusive enteral nutrition is a therapeutic concept to induce remission in children and adolescents with active Crohn's disease. A new area of nutritional research in pediatrics is potential immunonutrition in critically ill children. Formulae are enriched with single components or a combination of key substrates that might play a crucial role during intermediary metabolism in sepsis, inflammation, tissue healing, and growth. For pharmaconutrition, single components are investigated in a scientific stepwise procedure in order to identify effective disease-dedicated nutrition therapy. Any new formula needs to be evaluated, if possible in comparison to a normal diet or the reference formulation to demonstrate its safety and efficacy (equal or superior to standard formula).