Pediatric patients have characteristics such as a low capacity for storing energy/nutrients and high energy metabolism as compared those of adults. Because of the inherent characteristics that they are continually growing, supplying both rapid and adequate nutrition is of the utmost importance. In the case of children undergoing surgery (and particularly gastrointestinal surgery), there is a high possibility of a restricted supply of nutrition, and so active intervention to supply sufficient nutrition must be carried out. Of course, enteral nutrition is preferred, but continuous monitoring of nutrition is of paramount importance; thus, parenteral nutrition should be provided when necessary. Nutritional support requires continuous monitoring when and if complications arise. The complications of parenteral nutrition have yet to be overcome, so further research on this topic is certainly warranted.

Critically ill and injured patients admitted in the intensive care unit have a range of diseases with various severities. Their conditions should be assessed and the patients should receive specialized nutrition therapy depending on their condition. Like general intensive care, nutrition therapy is upgraded every few years with revised information to provide more idealized nutrition support. The main guidelines in this review are from the Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Their previous 2009 guidelines were revised and published in 2016. This review summarizes the 2016 SCCM/ASPEN guidelines focusing on the changes from the previous 2009 guidelines.

The Korean Society of Health-System Pharmacists (KSHP) and Korean Society for Parenteral and Enteral Nutrition (KSPEN) jointly performed a nation-wide questionnaire survey on the current state of Nutrition Support Team (NST) activity from March to May of 2016. The aim of the survey was to suggest ways to develop NST as well as to improve the relationship between the KSHP and KSPEN. Compared to the results of the 2005 survey, some progress was made in the activity of NST over the last decade. Not only was the activity of NST settled, but quantitative and qualitative growth was also achieved by activating rounds and regular meeting. On the other hand, the ratio of hospitals providing home care services has decreased. Therefore, further effort is needed for their revitalization.

Enteral nutrition is a method of nutritional support. If the gut works, its use is recommended for nutritional support. Enteral nutrition has several advantages; low cost, more physiologic, and prevention of mucosal atrophy and maintenance of gastrointestinal immunity. Enteral formula is the medical food used for enteral nutrition. Several types of enteral formula are used in clinical practice. I will hereby introduce the types and selection of enteral formula.

Korea Ministry of Health and Welfare launched legislation for reimbursement for Nutrition Support Team (NST) activities from August 1st, 2014, which can be applied as a flat rate fee per day once a week. The indicated patients are those with hypoalbuminemia, on parenteral nutrition or enteral nutrition, critically ill patients in intensive care unit’s, and any patient on suspicion of malnutrition by the physician in charge. NST should be comprised of a professional physician, an educated nurse, an educated pharmacist, and a professional and experienced dietitian. The maximum number of patients that can be treated by one NST is 30 per day. Such a reimbursement system has resulted in some complex problems with NSTs. The low price does not provide adequate reward for the team’s workload because the output of NST belongs to the department in charge and there is no ensured incentive. The Department of Health Insurance Review and Assessment Service cannot detect the quality problem of NST, non-compliance of physicians in charge. There are no stratified codes according to severity of disease and no difference between the first visit and the repeated visit. Every NST should be certified with accreditation and should participate in a qualified education program. Korea Health Insurance does not cover the fees for feeding tubes, formulas, and pumps. Evidence that NST activities can reduce medical cost of hospital-admitted in-patients is needed. Cost-effectiveness can be achieved by quality improvement of NST.