Safety of Decanted Enteral Formula Hung for 12 Hours in a Pediatric Setting

Abstract

Enteral nutrition has been an accepted mode of pediatric care for more than 40 years. Early reports in the literature documented high levels of bacterial contamination in enteral formulas delivered to patients. Safety standards for formula administration have not been universally followed. Evidence demonstrates that increased manipulation of the delivery system contributes to bacterial contamination. A prospective, descriptive study was conducted with 30 pediatric patients. They received continuous enteral feedings using decanted formula over a minimum hang time of 12 hours. Formula was delivered according to current practice recommendations. Cultures were obtained and sent to the laboratory initially and every 4 hours. Cultures from 30 patients (average age 6.4 years) were obtained at baseline, 4, 8, and 12 hours. Nasogastric, nasojejunal, gastrostomy, or gastrojejunostomy feeding tubes were used. Formulas administered were polymeric and peptide based. Of the 119 cultures obtained, 8 were either collected improperly or revealed a contaminant. Of the 111 useable cultures, 100 showed no growth, 6 had growth below the Food and Drug Administration threshold for contamination (95% acceptable), and 5 (5%) in 2 patients were considered positive, with all cultures growing coliforms. No patient had any clinical signs of bacterial gastroenteritis (increased stool output, fever, or clinical deterioration) over the 48 hours after data collection. Decanted enteral formula administered continuously over 12 hours in a pediatric hospital setting has a lower than expected rate of bacterial growth when recommended handling practices are followed.