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Are patients fed directly into the jejunum at risk of copper deficiency?
  1. Harriet Barraclough,
  2. Katarzyna Cooke
  1. Department of Paediatrics, Leeds General Infirmary, Leeds, UK
  1. Correspondence to Dr Harriet Barraclough, Leeds General Infirmary, Leeds LS1 3EX, UK; harriet.barraclough{at}nhs.net

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Scenario

A 7-year-old patient established on total parenteral nutrition inclusive of 0.11 mg/kg/day (0.17µmol/kg) of copper daily was transitioned to exclusive nasojejunal (NJ) feeding following a small bowel transplant. Prior to this, his serum copper level was stable at 18.6 µmol/L (reference range 11.0–22.0 µmol/L). Five months into NJ Peptamen Junior Advance feeds inclusive of 0.13 mg/kg/day copper, he was noted to have poor growth and had developed pancytopaenia. This prompted investigations, including a full serum nutritional screen, which led to detection of a low serum copper level of 1.7 μmol/L. He had no neurological abnormalities on examination. Questions were raised regarding whether jejunal feeding was causative in this trace element deficiency.

Structured clinical question

In individuals younger than 18 years (patient), are those fed exclusively into the jejunum (intervention), compared with those fed via the mouth or the stomach (comparison), more likely to develop copper deficiency (outcome)?

Search

An Ovid MEDLINE (1946–February 2019, week 5) and EMBASE (1947–2019, week 10) search was conducted on 9 March 2019 using the search terms ‘copper deficiency’ OR ‘low copper’ AND ‘jejunal feeding’ OR ‘jejunal nutrition’ OR ‘tube feeding’ OR ‘exclusive jejunal feeding’ OR ‘ feeding’ OR ‘jej$’ AND ‘paediat$’ OR ‘pediat$’. Results …

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