Constant Rate Enteral Nutrition Research Articles

Duodenal manometry in postobstructive enteropathy in infants with a transient enterostomy

Intestinal motility was studied in 11 children with a transient enterostomy secondary to a neonatal organic small intestine obstruction (5 total colon Hirschsprung's disease, 2 necrotizing enterocolitis, 1 intussusception, 3 ileal atresia). Eight children presented with a postobstructive enteropathy (severe grade I [5], moderate grade II [3]) and three were considered as controls (grade III). They were assigned to one of the three groups on the basis of the duration of parenteral nutrition and constant rate enteral nutrition needed and the oral feeding tolerance. Barium small intestine transit showed no persistant partial obstruction or peritoneal adhesions. The abnormal inert marker transit times were statistically correlated with the clinical groups as well as duodenal manometric abnormalities. Manometric recordings were caracterised by the absence (grade I) or abnormal phase III (grade II) of the migrating motor complex and decreased motility index (grades I and II). This study confirms that this enteropathy is due to a chronic alteration in motility induced by prenatal or postnatal obstructions.

Study of liver haemodynamics by colour Doppler flow imaging in children on total parenteral nutrition (TPN), constant rate enteral nutrition (CREN) and oral feeding (OF)

Study of liver haemodynamics by colour Doppler flow imaging in children on total parenteral nutrition (TPN), constant rate enteral nutrition (CREN) and oral feeding (OF)

The effect of artificial feeding on cholestasis, gallbladder sludge and lithiasis in infants: correlation with plasma cholecystokinin levels

The occurrence of hepatic cholestatis (judged by fasting serum bile acid levels), gallbladder sludge formation and lithiasis (ultrasonography) and their correlation with plasma cholecystokinin (CCK) levels was studied in a group of children on continuous total parenteral nutrition (TPN) (n = 95), and later in 40 of these children on cyclic TPN (cTPN). After resumption of oral feeding, 75 were studied on partial oral feeding (2–4 meals) and 40 on constant rate enteral nutrition (CREN) then 45 on total oral feeding (4–6 meals). Gallbladder sludge occurred in 23% of the children on TPN for 1 month and 32% of those on cTPN for 3 months. On CREN, the sludge rate was unchanged, but dropped significantly (17%) on partial oral feeding, and disappeared in children on total oral feeding. Serum bile acids were abnormal in 80% of children on TPN or cTPN and diminished significantly on total oral feeding only. Plasma CCK levels on TPN, cTPN and CREN were identical to fasting levels of children on total oral feeding. Plasma CCK levels increased significantly 1 h post-prandially during both partial (p < 0.02) and total oral feeding (p < 0.001). There was a significant negative correlation between the gallbladder sludge rate and CCK levels for all methods of feeding. This study demonstrates the frequent occurrence of hepatic cholestasis in infants, and the much lower frequency of gallbladder sludge in children compared to adults on TPN. Plasma CCK levels obtained during the different methods of feeding could explain the reduction and eventual disappearance of sludge following stimulation of CCK secretion by discontinuous feeding.

LENGTHENING OF VERY SHORT BOWEL BY LONGITUDINAL DlVISION

We report the cases of two children with a congenital very short bowel (18 and 20 cm) which has been surgically lengthened. In both cases, the short jejunum was distended because of a proximal atresia associated with laparoschisis in case n° 1, and in functional obstruction above a jejunocolic anastomosis (case n°2). Lengthening of the jejuna loop was performed following Bianchi's technique of longitudinal partition, modified with immediate end to end isoperistaltic anastomosis. The post operative course was uneventful with a satisfactory radiographic control. Further evolutin was: in case n° 1, under Parenteral Nutrition (PN), progressive oral refeeding from day 40 on, by constant rate enteral nutrition; PN defiitively stopped at 8 months, and totally fractionned feeding at 3½ years. In case n° 2, under PN, oral fractionned feeding onset at day 40, with enteral decontamination; at 8 months PN providing only 1/5 of caloric needs. The growth of both patients is normal. Adaptation of bowel is attested and development of villous hypertrophy in case n° 1. A third child has just had the same surgical procedure at 1 year of age for a very short bowel after a neonatal volvulus. In conclusion, bowel lengthening restores an efficient intestinal peristaltis without reduction of the absorptive surface. This surgical procedure is very useful to promote faster adaptation of very short distended bowels.

The effect of exclusive parenteral nutrition, constant rate enteral nutrition, partial meal feeding, normal oral feeding and etiology on the plasma pancreatic polypeptide levels in children

Plasma pancreatic polypeptide (PP) levels were determined by radioimmunoassay in 100 children. Of the 81 children on Total Parenteral Nutrition (TPN), 32 were studied after cyclic TPN (cTPN), 66 after Partial Meal Feeding plus Parenteral Nutrition, 25 after Constant Rate Enteral Nutrition and 18 during Normal Oral Feeding. Nineteen controls received normal alimentation. PP levels during TPN (172 ± 17 pg/ml), cTPN (150 ± 23) and Constant Rate Enteral Nutrition (200 ± 27) were similar to each other and to pre-prandium (p), Normal Oral Feeding (198 ± 22) and controls (196 ± 40). PP increased (p < 0.05) in post-prandium (pp), Partial Meal Feeding (233 ± 23) compared to TPN, cTPN, p Normal Oral Feeding and p controls, but remained at half that of pp Normal Oral Feeding (387 ± 58) and pp controls (410 ± 91, p < 0.001). The p PP levels were significantly reduced in chronic intestinal pseudo-obstruction (CIPO) (90 ± 22, p < 0.02) and short bowel (length < 100 cm) (76 ± 17, p < 0.001), as compared to controls. This study indicates that TPN or Constant Rate Enteral Nutrition do not modify basal PP levels. Normal Oral Feeding and Partial Meal Feeding produce a significant pp stimulation of PP release. Intestinal pathology can interfere with p plasma PP levels.

Gastric pepsin and acid secretion during total parenteral nutrition and constant-rate enteral nutrition in infancy.

Total Parenteral Nutrition (TPN) and constant rate enteral nutrition (CREN) are widely used: their effects on gastric function, especially pepsin secretion, are unknown. Basal and pentagastrin-stimulated pepsin (BPO, MPO) and acid (BAO, MAO) secretions were measured in three groups of infants: controls (14 infants fed normally), TPN groups (seven infants on TPN), CREN groups (14 infants on CREN). The MAO and MPO of the TPN group were significantly lower than controls (p less than 0.02), and the ratio of pentagastrin-stimulated PO/AO did not change, suggesting a large decrease of acid gastric function in the TPN group. BPO was not different from controls and BAO was significantly higher because of amino acids perfusion. The data for CREN group were not different from those of the control group, despite the fact that 11 infants were on TPN before CREN. These results demonstrate that TPN causes decreases in both acid and pepsin secretions in human infants. When TPN children are placed on CREN, these secretions return to normal.

Effect of total parenteral nutrition, constant rate enteral nutrition, and discontinuous oral feeding on plasma cholecystokinin immunoreactivity in children.

Plasma cholecystokinin (CCK) levels were measured by radioimmunoassay in 100 children (mean age: 20 months) on various types of artificial nutrition. Of the 81 children given total parenteral nutrition (TPN), 32 were studied while on cyclic TPN (cTPN), 66 while on partial fractioned feeding completed by parenteral nutrition, 25 while on constant rate enteral nutrition, and 18 while on total discontinuous oral feeding. The remaining 19 control cases were on normal alimentation. Plasma CCK levels during TPN (21.4 +/- 1.6 pg/ml), cTPN (21.8 +/- 2.7 pg/ml), and constant rate enteral nutrition (26.4 +/- 2.8 pg/ml) were not significantly different from each other and were similar to preprandial total discontinuous feeding (21 +/- 2 pg/ml) and control (22.6 +/- 3.5 pg/ml) levels. The postprandial CCK level increased significantly in partial fractionated feeding (33.6 +/- 3.3 pg/ml, p less than 0.02) but remained half that of postprandial total discontinuous oral feeding (75.6 +/- 6.6 pg/ml, p less than 0.001) and postprandial controls (75 +/- 7 pg/ml, p less than 0.001). Thus, basal and stimulated CCK levels are similar in children and adults, and the use of long-term artificial nutritional techniques does not modify the feeding stimulation of CCK. Plasma CCK levels during TPN and constant rate enteral nutrition are similar to fasting values, indicating a possible role for CCK in the biliary sludge.

Effect of Total Parenteral Nutrition, Constant Rate Enteral Nutrition, and Discontinuous Oral Feeding on Plasma Cholecystokinin Immunoreactivity in Children

SummaryPlasma cholecystokinin (CCK) levels were measured by radioimmunoassay in 100 children (mean age: 20 months) on various types of artificial nutrition. Of the 81 children men total parenteral nutrition (TPN). 32 were studied while on cyclic TPN (cTPN). 66 while on partial fractioned feeding completed by parenteral nutrition. 25 while on constant rate enteral nutrition, and 18 while on total discontinuous oral feeding. The remaining 19 control cases were on normal alimentation. Plasma CCK levels during TPN (21.4 ± 1.6 pg ml), cTPN (21.8 ± 2.7 pg ml), and constant rate enteral nutrition (26.4 ± 2.8 pg ml) were not significant different from each other and were similar to preprandial total discontinuous feeding (21 ± 2 pgml) and control (22.6 ± 3.5 pg ml) levels. The postprandial CCK level increased significantly in partial fractioned feeding (33.6 ± 3.3 pg ml. p 0.02) but remained half that of postprandial total discontinuous oral feeding (75.6 ± 6.6 pg ml. p 0.001) and postprandial controls (75 ± 7 pg ml. p 0.001). Thus, basal and stimulated CCK levels are similar in children and adults, and the use of long‐term artificial nutritional techniques does not modify the feeding stimulation of CCK. Plasma CCK levels during TPN and constant rate enteral nutrition are similar to fasting values, indicating a possible role for CCK in the biliary sludge.

Correlation between plasmatic cholecystokinin (CCK) levels and biliary tract sludge in children during total parenteral nutrition (TPN), constant rate enteral nutrition (CREN) and fractionned feeding : [formula omitted], C. Bernard, J.A. Chayvialle, P.Y. Robillard, L.Berl, J.P. Cézard and J.Navarro — Hôpital Bretonne — Paris — INSERM U 35 — Lyon ; France -

Correlation between plasmatic cholecystokinin (CCK) levels and biliary tract sludge in children during total parenteral nutrition (TPN), constant rate enteral nutrition (CREN) and fractionned feeding : [formula omitted], C. Bernard, J.A. Chayvialle, P.Y. Robillard, L.Berl, J.P. Cézard and J.Navarro — Hôpital Bretonne — Paris — INSERM U 35 — Lyon ; France -

O.17 Influence of constant rate enteral nutrition (CREN) on acid and pepsin secretion in infants

O.17 Influence of constant rate enteral nutrition (CREN) on acid and pepsin secretion in infants

Effect of constant rate enteral nutrition on gastric inhibitory polypeptide (GIP) secretion in infants

Effect of constant rate enteral nutrition on gastric inhibitory polypeptide (GIP) secretion in infants

Sleep related growth hormone and prolactin secretion in children during constant rate enteral nutrition.

The aim of this study was to investigate the nocturnal secretion of growth hormone and prolactin in a particular model where nutrients are delivered continuously. Six children with severe intestinal diseases undergoing total constant rate enteral nutrition for 1.5 to 8 months have been studied; all children had a normal nutritional status at the time of the recording. Sleep patterns were studied by the usual polygraphic methods from 10 p.m. to 8 a.m. Blood samples were taken every 20 min through an indwelling catheter for growth hormone and prolactin plasma level determination. Several growth hormone peaks were observed with a peak always secreted in connection with stage III-IV of the first cycle. This early peak was significantly higher than the following ones. Nocturnal patterns of prolactin secretion showed individual differences characterized by a series of episodic releases which consisted of a few long rises (4 patients) and several small fluctuations; no correlation was found with the sleep patterns; no increase in the level throughout the night was observed. Loss of the rhythmicity of alimentation does not alter the secretion of growth hormone during sleep.

Total parenteral nutrition (TPN) and constant rate enteral nutrition (CREN) for management of necrotizing enterocolitis in newborns : [formula omitted] Dept. of Paediatric Gastroenterology, Hospital Bretonneau, Paris 75018, France

Total parenteral nutrition (TPN) and constant rate enteral nutrition (CREN) for management of necrotizing enterocolitis in newborns : [formula omitted] Dept. of Paediatric Gastroenterology, Hospital Bretonneau, Paris 75018, France

Serum vitamin A, retinol-binding protein, prealbumin and zinc in infants during total parenteral nutrition and constant rate enteral nutrition: [formula omitted] Unite de gastroenterologie et nutrition, Clinique Medicale Infantile A, Laboratoire biochimie II — CHR Purpan, 31052 Toulouse Cedex, France

Serum vitamin A, retinol-binding protein, prealbumin and zinc in infants during total parenteral nutrition and constant rate enteral nutrition: [formula omitted] Unite de gastroenterologie et nutrition, Clinique Medicale Infantile A, Laboratoire biochimie II — CHR Purpan, 31052 Toulouse Cedex, France