Early Feeding Research Articles

Early Enteral Feeding Restores Neurofilament Light Chain Serum Levels in Preterm Newborns

Background: Positive effects of early nutritional strategies on neurological outcomes have been observed when nutrients were administered by the enteral route, especially during the first week of life. Evidence reports that serum neurofilament light chain (NfL), a structural protein of neurons, is a specific and reliable biomarker of neuronal damage. Objective: The present study aimed to investigate the effect of early enteral nutrition (EN) in minimizing neuroaxonal damage and assessing NfL serum levels in preterm neonates Methods: Fifty-four preterm neonates without severe brain impairment and 20 full-term babies as controls were enrolled from the Neonatal Intensive Care Unit at the Policlinico Umberto I in Rome. We performed blood sampling at birth (day of life 0 - DoL 0) in 20 full-term newborns and in 19 pre-term infants. Furthermore, we executed blood sampling at DoL 28 in other 22 pre-term newborns who received early enteral nutrition (EN) within the third DoL (Early-EN) and in 13 other pre-term newborns who received EN after the third DoL (Late-EN). Results: Serum levels of NfL were higher in preterm babies when compared to full-term neonates, at DoL 0 (48.81 ± 9.4 vs. 11.67 ± 1.4 pg/ml; p = 0.007). Interestingly, at DoL 28, serum NfL was significantly decreased in the Early-EN newborns compared to the Late-EN groups (15.22 ± 2.0 vs. 50.05 ± 17.9 pg/ml; p = 0.03). Conclusions: It was shown that early enteral feeding, within the first week of life, could be a useful tool for limiting neurological impairment in pre-term neonates by restoring NfL.

A novel chemokine binding protein 1-like gene is vital for the blood pool development and engorgement of the hard tick Haemaphysalis longicornis

Tick saliva modulates host responses during a blood feeding process. We identified a novel chemokine binding protein 1-like (HLCBP1-like) gene from the salivary glands of the Asian longhorned tick, Haemaphysalis longicornis. The HLCBP1-like protein, lacking a well-defined conserved domain, showed structural similarity to evasin, a chemokine binding protein from the brown dog tick, Rhipicephalus sanguineus. A preliminary knockdown study of HLCBP1-like revealed that ticks with reduced expression of this gene, halted feeding in the early feeding phase, and did not fully-engorge, unlike the control dsRNA (malE) injected ticks. Also, knockdown ticks induced cellular immune responses in the host skin, similar to control dsmalE-injected ticks, but did not show hemorrhage. These findings suggest that HLCBP1-like may play a modulatory role in the slow feeding phase.

The effects of early feeding with different pre-starter diets on growth performance, morphological development and microorganism content of the small intestine of broiler chicks

The present study was conducted to compare the effects of feeding 2 different pre-starter diets to broiler chicks at 2 different times on growth performance, slaughtering parameters, morphological development of the small intestine segments and the microorganism content of the ileum of broilers. A total of 600 day-old Ross 308 male broiler chicks were randomly distributed into 5 treatment groups with 5 replicates of 24 chicks each. The experimental treatments included: SD10: broiler chicks were fed a corn-soybean meal-based starter diet for 0-10 days; 1PSD5: chicks were fed a first pre-starter diet based on corn-soybean meal for 0-5 days, afterwards they were fed a starter diet based on corn-soybean meal for 5-10 days; 1PSD10: chicks were fed the first pre-starter diet for 0-10 days; 2PSD5: chicks were fed a second pre-starter diet based on rice-soybean meal for 0-5 days, afterwards they were fed a starter diet based on corn-soybean meal for 5-10 days; 2PSD10: chicks were fed the second pre-starter diet for 0-10 days. Broilers were fed a basal diet based on corn and soybean meal until the end of the experimental period. The 1PSD5, 1PSD10, 2PSD5 and 2PSD10 treatments significantly increased final body weight (BW) and BW gain, decreased feed intake (FI) and improved feed conversion ratio (FCR) of broilers from 0 to 42 day compared to the SD10 treatment. The lowest FI and the best FCR of broilers during the period of 0 to 42 day were obtained by the 2PSD5 treatment. The 1PSD5, 1PSD10, 2PSD5 and 2PSD10 treatments significantly enhanced the hot- and cold-carcass yields and villus heights (VHs) and decreased crypt depths of small intestine segments of broilers on day 42. However, the experimental treatments did not significantly affect the the E.coli and Lactobacillus contents of ileum of broilers on day 42. In conclusion, feeding of chicks with the pre-starter diet based on rice-soybean meal supplemented with enzyme complex and synbiotic for 0-5 days was a more effective treatment in terms of performance especially FI and FCR, carcass yields and VHs of small intestine segments of broilers.

Oral Gastrografin: A Safe Alternative in Meconium Obstruction of Prematurity

Meconium obstruction of prematurity is primarily seen among very low birthweight or extremely low birthweight premature babies, causing low intestinal obstruction. It may delay the establishment of early full enteral feeding and compromise nutrition or cause obstruction requiring surgery or intestinal perforation. Currently, the management is mainly based on expert opinion and low-quality evidence. Conventional hyperosmolar contrast enema and gastrografin enema may not reach the site of obstruction because of the proximal nature of the meconium obstruction. Oral gastrografin is an effective and safe alternative for relieving meconium obstruction in a 28-week preterm baby. This avoids the need for surgery. This article highlights the use of oral route of gastrografin as a good nonsurgical alternative in extreme preterm babies in resource-limited circumstances.

Early human milk feeding: Relationship to intestinal barrier maturation and postnatal growth.

Early exposure to mother's own milk (MOM) promotes intestinal barrier maturation in preterm infants. We hypothesized (1) donor human milk (DHM) supplementation reduces intestinal permeability (IP) similar to exclusive MOM and (2) early HM exposure and low IP at 7-10 days postnatal age (PNA) are associated with improved growth outcomes. IP was measured by the standard sugar absorption test (SAT) in infants <33 weeks gestation between 7-10 days PNA. Nutritional and anthropometric data were recorded. Postnatal growth failure (PNGF) was defined as a decrease in weight z-score >1 from birth to discharge to home. Of 158 preterm infants, the mean (SD) gestational age was 29.9(2.3) weeks and birthweight 1388(424) g. Diet prior to SAT was exclusive MOM [N = 55(35%)], DHM ± MOM [N = 52(33%)], or preterm formula±MOM [N = 51(32%)]. The mean Lactulose(La)/Rhamnose(Rh) ratio was lower in the exclusive MOM [0.06(0.07)] and DBM ± MOM [0.05(0.07)] groups compared to the preterm formula±MOM group [0.11(0.11)], p < 0.01). Cumulative intake >150 ml/kg MOM ± DHM, but not preterm formula within 7-10 days PNA was associated with early intestinal barrier maturation. Low IP was not associated with lower risk of PNGF at discharge. Low IP is associated with cumulative intake of MOM alone or supplemented with DHM > 150 ml/kg within 7-10 days PNA. Clinicaltrials.gov NCT01756040 ; web link to study on registry: https://clinicaltrials.gov/study/NCT01756040 . Key message Early intestinal barrier maturation is associated with cumulative intake of exclusive MOM alone or supplemented with DHM > 150 ml/kg within 7-10 days after birth, but is not associated with lower risk of PNGF at time of discharge. What it adds to existing literature? This observational study is the first study to demonstrate that supplemental DHM promotes intestinal barrier maturation similar to MOM alone. What is the impact? The findings underscore the importance of early introduction of human milk feeds as MOM or MOM supplemented with DHM in sufficient volume to promote early intestinal barrier maturation.

Prevention of Infectious Complications in Acute Pancreatitis

AIM OF STUDY. The study was aimed to evaluate the effectiveness of treating acute pancreatitis by early enteral nutrition and selective introduction of nutritional mixtures directly into the initial sections of the jejunum, bypassing the duodenum.MATERIAL AND METHODS. A comprehensive treatment method for acute pancreatitis was developed based on the use of a pancreatoduodenal catheter. The method focuses on preventing intestinal failure syndrome by isolating the duodenum and preventing any liquid from entering it while ensuring the selective introduction of glucose-saline solutions and/or enteral nutritional mixtures directly into the initial sections of the jejunum. Several Russian clinics are currently conducting the research approved by local ethics committees. This article presents preliminary results from the data analysis. The study included moderate to severe forms (according to the 2012 Atlanta classification) of acute biliary pancreatitis without indications for endoscopic retrograde cholangiopancreatography, as well as alimentary-alcoholic pancreatitis. The first group of patients received standard therapy according to the 2020 clinical guidelines of the Russian Society of Surgeons. The second group received standard therapy combined with the new selective enteral nutrition method. The observation period lasted until the end of the hospital treatment, including five mandatory visits and a final visit to the physician. A follow-up survey was conducted three months or more after discharge to identify delayed episodes of acute pancreatitis complications, focusing on the incidence of infectious complications and surgical interventions.RESULTS. A total of 148 patients were treated. Patients were evenly distributed by etiology, gender, age, and body mass index. The analysis revealed that the number of patients with infectious complications decreased from 19.3% in the comparison group to 6.67% in the study group (p=0.041). The number of patients requiring surgical interventions was 5.0% in the study group compared to 19.3% in the comparison group (p=0.017).CONCLUSIONS. The study demonstrated that the use of the new method in the comprehensive treatment of acute pancreatitis, including early enteral feeding at the onset of the disease, may improve the course of the disease by reducing the incidence of infectious complications and the number of necessary surgical interventions.

Enhanced recovery after fetal spina bifida surgery: global practice.

Enhanced recovery after surgery (ERAS) protocols are multimodal evidence-based care plans that have been adopted for multiple surgical procedures to promote faster and better patient recovery and shorter hospitalization. This study aimed to explore whether worldwide fetal therapy centers offering prenatal myelomeningocele repair implement the ERAS principles and to provide recommendations for improved perioperative management of patients. In this survey study, a total of 53 fetal therapy centers offering prenatal surgery for open spina bifida were identified and invited to complete a digital questionnaire covering their pre-, intra- and postoperative management. An overall score was calculated per center based on compliance with 20 key ERAS principles, extrapolated from ERAS guidelines for Cesarean section, gynecological oncology and colorectal surgery. Each item was awarded a score of 1 or 0, depending, respectively, on whether the center did or did not comply with that principle, with a maximum score of 20. The questionnaire was completed by 46 centers in 17 countries (response rate, 87%). In total, 22 (48%) centers performed exclusively open fetal surgery (laparotomy and hysterotomy), whereas 14 (30%) offered both open and fetoscopic procedures and 10 (22%) used only fetoscopy. The perioperative management of patients undergoing fetoscopic and open surgery was very similar. The median ERAS score was 12 (range, 8-17), with a mean ± SD of 12.5 ± 2.4. Center compliance was the highest for the use of regional anesthesia (98%), avoidance of bowel preparation (96%) and thromboprophylaxis (96%), while the lowest compliance was observed for preoperative carbohydrate loading (15%), a 2-h fasting period for clear fluids (20%), postoperative nausea and vomiting prevention (33%) and early feeding (35%). ERAS scores were similar in centers with a short (2-5 days), medium (6-10 days) and long (≥ 11 days) hospital stay (mean ± SD, 12.9 ± 2.4, 12.1 ± 2.0 and 10.3 ± 3.2, respectively, P = 0.15). Furthermore, there was no significant association between ERAS score and surgical technique or case volume. The perioperative management of fetal spina bifida surgery is highly variable across fetal therapy centers worldwide. Standardized protocols integrating ERAS principles may improve patient recovery, reduce maternal morbidity and shorten the hospital stay after fetal spina bifida surgery. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Prospective Outcomes of Standardized Non-operative Management of Pancreatic Trauma With Ductal Injury in Children: Less is More

BackgroundTraumatic pancreatic laceration with ductal injury in children can be managed non-operatively (NOM); however, variable management affects outcomes. We hypothesized that a standardized management approach with early feeding and limited resource utilization is safe and improves outcomes. MethodProspective, multicenter study of 13 pediatric trauma centers (2018–2022). Children with blunt pancreatic trauma with ductal injury were managed per a standard NOM pathway. Outcomes were compared to a historical NOM cohort with variable management. ResultsOf 22 patients, the median age was 7.5 years (range 1–14 years). Low-fat diet was started at median 4 days [IQR 2–7] and median hospital stay was 8 days [IQR 4–10]. One patient failed NOM and underwent distal pancreatectomy. Of the rest, most (17/21, 81%) had early recovery and discharged in median 6 days [IQR 4–8.25] while 4 (19%) had prolonged recovery (median stay 24 days, IQR 19.8–30.5) and higher peri-pancreatic cyst development (early 23.5% vs prolonged 75%,p = 0.05). Pancreatic ascites at presentation correlated with cyst development (p < 0.0001). Endoscopic stent (optional) was placed in 33% and did not prevent cyst development. Delayed exocrine pancreatic insufficiency was noted in 1 patient. Compared to the historic cohort (32 patients), TPN use was lower (pre-protocol 56% vs post 23%, p = 0.02), days to diet was shorter (pre-protocol 7 vs post 4; p = 0.03), and cyst development was lower (pre-protocol 81% vs post 33%, p < 0.001). ConclusionChildren with traumatic pancreatic ductal injury can be safely managed per the PTS NOM clinical pathway and most recover rapidly. Pancreatic ascites may predict pseudocyst formation. Levels of EvidenceIV. Study type: therapeutic, comparative.

Parent-reported offering of allergen foods to infants during complementary feeding: An observational study of New Zealand infants

The prevalence of food allergies in New Zealand infants is uncertain but is believed to be similar to Australia, exceeding 10%. Current recommendations for reducing food allergy risk are to offer all major food allergens to infants from as early as six months of age (start of complementary feeding), and before 12 months of age. However, little is known regarding parental practices around introducing major food allergens. This study aimed to explore parental offering of major food allergens to infants during complementary feeding, and parent-reported food allergies. The cross-sectional study is a secondary analysis of the multi-centre (Auckland and Dunedin) First Foods New Zealand study of 625 parent-infant dyads. Participants were recruited in 2020–2022 when infants were 7–10 months of age. Questionnaires assessed sociodemographic characteristics, complementary feeding approach, infant pouch use and parental responses to five food allergy questions. All major food allergens had been offered to only 17% of infants by 9–10 months of age. Having offered egg, peanut, tree nuts, sesame, soy and seafood was more commonly associated with using a baby-led complementary feeding approach than a parent-led approach (p < 0.001). Frequent baby food pouch use was associated with a lower likelihood of offering egg and peanut (both p < 0.001). Overall, 12.6% of infants had a reported food allergy, with symptomatic response after exposure being the most common diagnostic tool. Most infants are not offered all major food allergens during early complementary feeding, with some parents actively avoiding major food allergens in the first year of life. These results provide up-to-date knowledge of parental practices, highlighting the need for more targeted advice and strategies to improve parental engagement with allergy prevention and diagnosis.

Different time-restricted feeding patterns potentially modulate metabolic health by altering tryptophan metabolism of gut microbes in pigs

Time-restricted feeding has emerged as a preferred approach for alleviating metabolic disorders, but the potential microbiological mechanism remains poorly understood. This study used a growing pig model to mimic common-sense eating habits. Four feeding patterns were set up, including ad libitum feeding (ALF) for daily irregulated eating habits, time-restricted feeding (TRF) for three meals a day, early time-restricted feeding (eTRF) for skipping dinner and mid-day time-restricted feeding (mTRF) for skipping breakfast. The results showed that the three time-restricted feeding patterns (TRF, eTRF and mTRF) resulted in a reduction of hepatic fat accumulation and a decrease in hepatic function markers compared to the ALF pattern. However, this was independent of food consumption. Transcriptome analysis of the liver showed that the three time-restricted feeding patterns downregulated the expression of genes related to gluconeogenesis, β-oxidation, lipid accumulation, and urea cycle, and upregulated the expression of genes related to lipogenesis and glycolysis compared to the ALF pattern. Microbiome and metabolome analyses showed that Lactobacillus enriched in the colon of pigs in three time-restricted groups were negatively correlated with serum triglyceride. Meanwhile, three time-restricted feeding patterns elevated the levels of the microbial metabolite indole-3-lactic acid, which was further confirmed to reduce excessive hepatic lipid accumulation in vitro. Overall, time-restricted feeding potentially improved metabolic health by modulating gut microbiota and metabolites.

Comparative Analysis of Early Versus Late Feeding Post-percutaneous Endoscopic Gastrostomy Tube Placement: A Systematic Review and Meta-Analysis.

In clinical practice, tube feedings have been delayed after the percutaneous endoscopic gastrostomy (PEG) tube placement. Previous studies, including a meta-analysis in 2008, have shown that it is safe to start tube feeding ≤ 4h of PEG tube placement. However, it is still a common practice to delay the initiation of tube feeding up to 24h after PEG tube placement. We have performed an updated analysis of studies comparing early versus delayed tube feedings following PEG placement. Major databases like PubMed, EMBASE, and Web of Science were searched in June 2022 for randomized controlled trial (RCT) studies reporting on comparative outcomes with early (< or = 4h) versus delayed (> 4h) feeding after PEG tube placement in adult patients. The primary outcomes in our study include complication rates and mortality rates within 72h of the procedure. The outcomes were reported as pooled odds ratio (95% confidence interval (CI) (Moole et al. in Indian J Gastroenterol. 35:323-330, 2016), p value, I2 values). A total of 212 individuals in the early feeding group and 215 individuals in the late feeding group were analyzed from six studies. The pooled odds ratio of total complication events between early and late feed groups was 0.86 (CI 0.51-1.45, p = 0.58). The pooled odds ratio of fever, vomiting, and local infection was 0.94 (CI 0.186-4.74, p = 0.94), 1.0 (CI 0.38-2.65, p = 0.9), and 1.25 (0.36-4.3, p = 0.72), respectively, between early and late feeding post-PEG tube placement. In conclusion, this meta-analysis confirms that early feeding ≤ 4h after PEG placement does not increase the odds of poor outcomes or mortality, and it is a well-tolerated, safe, and effective alternative to delayed feeding. Furthermore, early feeding may decrease hospital stays and healthcare costs.

Effectiveness of Early Feeding versus Conventional Protocol after Stoma Reversal in Adult Surgical Practices.

To compare the effectiveness of early feeding and conventional feeding protocol after stoma reversal in adult surgical practices. Randomised controlled trial. Place and Duration of the Study: Department of General Surgery, District Headquarters Hospital Mardan, Pakistan, from January 2020 to July 2022. A total of 72 patients enrolled in the surgical unit for stoma reversal were included in this study. After applying the exclusion criteria, 68 patients were randomised in two equal groups of 34 patients each. In Group A, patients were allowed oral liquid feed within 24 hours after surgery while in Group B oral liquid feed was allowed after 72 to 96 hours when the nasogastric tube was removed and bowel functions were returned. Efficacy, safety, and tolerability were evaluated from outcomes such as postoperative ileus, anastomosis leakage, infection of the wound, and length of hospital stay. The age range in this study was from 18 to 43 years with mean ± SD of 31.602 ± 6.75 years. There were 41 (60.29%) males while 27 (39.71%) females in this study and the male population was dominant in both groups. The results were significantly in favour of Group A, where 28 (82.35%) patients did not have postoperative ileus compared to 17 (50%) patients in Group B (p = 0.004). Wound healing was also significantly better in Group A compared to Group B, where 30 (88.23%) patients had no wound infection compared to 21 (61.76%), respectively (p = 0.001). There was no difference between both groups regarding anastomotic leakage. Length of hospital stay was significantly shorter in Group A (3.117 ± 0.87 days) compared to Group B (5.617 ± 1.43 days) (p = 0.001). Early feeding after stoma reversal is effective, minimises the postoperative complications, and leads to shortening of hospital stay in adult surgical practices. Anastomosis leakage, Early feeding, Length of hospital stay, Stoma reversal.

Early oral feeding within two hours for parturients compared with delayed oral feeding after cesarean section: a systematic review and meta-analysis

BackgroundIt is recommended that postpartum women undergo early oral feeding (EOF) after cesarean section (CS). However, the optimal early time for oral feeding after CS is unclear. We performed a meta-analysis to assess whether EOF within two hours is superior to delayed oral feeding (DOF) after CS.MethodsThe PubMed, Embase, Cochrane Library, and Google Scholar databases were searched from inception to February 2024 for randomized controlled trials comparing EOF versus DOF after CS. Primary outcomes included the time to normal bowel function. The secondary outcomes included postoperative complications, the time to ambulation after surgery, the time to removal of the catheter, the time to start of a regular diet, the length of hospital stay and patient satisfaction.ResultsData from 8 studies involving a total of 2572 women were obtained. EOF within two hours was significantly associated with shorter durations of return bowel movement (WMD, − 2.41, 95% CI, − 3.80–− 1.02; p < 0.001; I2 = 96%), passage flatus after surgery (WMD, − 3.55, 95% CI, − 6.36–− 0.75; p = 0.01; I2 = 98%), ambulation after surgery (WMD, − 0.96, 95% CI, − 1.80–− 0.13; p = 0.02; I2 = 53%), removal of catheters (WMD, − 15.18, 95% CI, − 25.61–− 4.74; p = 0.004; I2 = 100%) and starting a regular diet (WMD, − 7.03, 95% CI, − 13.13–− 0.92; p = 0.02; I2 = 99%) compared with DOF. EOF was not related to increased vomiting (RR, 1.08; 95% CI, 0.74–1.57; p = 0.69; I2 = 0%), nausea (RR, 1.21; 95% CI, 0.83–1.77; p = 0.33; I2 = 37%), abdominal distension (RR, 0.76; 95% CI, 0.31–1.89; p = 0.55; I2 = 54%) or ileus (RR, 0.91; 95% CI, 0.40–2.06; p = 0.81; I2 = 12%).ConclusionsThis meta-analysis provides evidence that EOF within two hours after CS has comparable safety with DOF, and can accelerate the recovery time for normal bowel function.Trial registration: INPLASY202320055.

Intestinal Anastomosis During Enterostomy Takedown Using a 5 mm Miniature Endostapler Compared to Conventional Handsewn Technique

AimEnterostomy takedown is common in neonates with Hirschsprung’s disease, anorectal malformations, or necrotizing enterocolitis. Stapled bowel anastomosis has become routine in adults, but size of up to 12 mm diameter precludes performing enterostomy takedown in young infants using regular intestinal staplers. After the introduction of miniature (5 mm diameter) staplers, we increasingly used them for enterostomy takedown. This study compares enterostomy takedown using the miniature stapler (MS) to the conventional hand-sewn (HS) technique. MethodsRetrospective review of all children <3 years of age undergoing enterostomy closure at our institution from 2008 to 2023 were retrospectively reviewed. Demographics, operative times, complications, and outcomes were compared between those who underwent the procedure using MS versus HS technique. Data are quoted as median (range). ResultsA total of 102 patients were enrolled, including MS (n = 26) and HS (n = 76) anastomoses. There were no statistical differences in age, sex, or indication for enterostomy. Enterostomy takedown using MS was faster [82.5 (44–218) versus 147 (52–381) minutes, p < 0.001) and associated with earlier commencement of feedings [2 (1–6) versus 4 (1–24) days, p = 0.001], as well as shorter length-of-stay [6 (2–20) versus 17 (3–52) days, p < 0.001), compared to the HS technique. ConclusionsThis is the first study that systematically evaluates the novel 5 mm ministapler for enterostomy takedown in young children. Its use was associated with quicker operative times, earlier feeding and shorter hospital stay. These findings are especially relevant in children with co-morbidities who do not tolerate longer anesthesia times. Randomized, controlled trials should be performed to prospectively confirm these findings. Level of EvidenceLevel III, retrospective comparative study.

Oral Feeding Readiness Assessment Tools for Preterm Infants

Due to their underdeveloped physiological maturity, preterm infants often face challenges related to sucking, breathing, and swallowing coordination during initial feeding. This lack of coordination may lead to episodes of apnea and choking, resulting in unstable vital signs. Preterm infants with this issue must gradually learn oral feeding skills appropriate to their developmental stage. Registered nurses play a critical role in assessing the right time to transition from tube to oral feeding and in providing a safe and positive oral feeding experience. In this article, three validated assessment tools for feeding premature infants are introduced, accompanied by clinical research data demonstrating their use in clinical practice. These three tools include: (1) the Neonatal Oral Motor Assessment Scale, which is applied to evaluate oral motor skills using observations of nonnutritive sucking and the sucking state during the two minutes before feeding; (2) the Premature Oral Feeding Readiness Assessment Scale, which is used to assess readiness for oral feeding in preterm infants; and (3) the Early Feeding Skills assessment, which is used to evaluate the oral feeding skills of preterm infants. These tools aid nurses in helping preterm infants achieve independent oral feeding, facilitating earlier discharge and return to home. The clinical implications and effectiveness of these tools are also discussed to provide to nurses the means and confidence necessary to apply them appropriately in clinical settings.

Implementation of enhanced recovery protocols in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for metastatic ovarian cancer following neoadjuvant chemotherapy. A feasibility study

ObjectiveThe aim of this study is to evaluate the implementation of the elements of enhanced recovery (ERAS) protocols in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for metastatic ovarian cancer. ERAS protocols have shown improvement in the perioperative outcomes of patients who underwent cytoreductive surgery for metastatic ovarian cancer by reducing the length of stay as well as the postoperative complications and by improving patients’ postoperative experience. MethodsThis is a feasibility study involving retrospective analysis from (31) patients who underwent cytoreductive surgery and HIPEC versus (35) a control group that underwent cytoreductive surgery only, prior to the introduction of the HIPEC programme for metastatic ovarian cancer. All patients had undergone neoadjuvant chemotherapy prior to surgery. We compared the compliance for each element of the ERAS protocol between the two study groups. ResultsWe analyzed data from 66 patients, 31 in HIPEC group and 35 in the control goup. We found no significant difference in the patients’ characteristics between the two groups and there were no differences in the implementation of 8 elements of the ERAS protocols (100 % for both groups). The use of nasogastric tube was more frequently observed in patients undergoing surgery and HIPEC compared to those undergoing surgery alone (42 % vs 0 %, respectively; p < 0.001). The number of patients who were mobilized on the first postoperative day was higher in the group undergoing surgery and HIPEC (87.1 % vs 57.1 %, respectively; p = 0.007), however there was no significant difference in the percentage of patients that had early removal of the urinary catheter (p = 0.12), nor in the percentage of patients that received early feeding (p = 0.18). Finally, there were no statistically significant differences in the complication rates, the length of hospital stay and the re-admission rates between the two groups. ConclusionEnhanced recovery protocols can be implemented safely in patients undergoing cytoreductive surgery and HIPEC for ovarian cancer.

Liberal Fluid Resuscitation is Associated with Improved Outcomes in Pediatric Acute Pancreatitis

To evaluate outcomes of children from an observational cohort registry of index acute pancreatitis (AP) admissions managed with different types and rates of intravenous fluid therapy. Patients with index admission of AP between 2013 and 2023 were included. Those who received >1.5x the maintenance intravenous fluid rate were assigned to the liberal fluid group, and patients who received <1.5x maintenance fluids were assigned to the conservative group. Outcomes including intensive care unit admission rate, organ dysfunction, local pancreatic complications, and AP severity were evaluated. Influence of early enteral feeding and fluid composition on outcomes and clinical course were also analyzed. Patients who received liberal fluids were less likely to be admitted or transferred to the intensive care unit compared with those receiving conservative management (OR, 0.32; 95% CI, 0.12-0.80; P=.015). The liberal fluid group with early feeding had the lowest rate of moderate/severe manifestations of AP compared with other combinations of diet and fluid orders. Patients within the liberal fluid group who received the highest fluid rates (>2x maintenance) did not have higher rates of organ dysfunction or severe disease. Children with AP may stand to benefit from liberal fluid therapy and continued diet compared with more conservative fluid resuscitation and nothing by mouth status.

Repair of Type C Tracheo-esophageal Fistula/Esophageal Atresia With or Without Trans Anastomotic Tube: A Pilot Randomized Controlled Trial

BackgroundThe use of trans anastomotic feeding tube (TAFT) during the repair of Esophageal atresia/Tracheo-esophageal fistula (EA/TEF) aims to enhance outcomes by enabling early feeding, reducing the requirement for parenteral nutrition, and reducing complications such as anastomotic leak by stenting the anastomosis. However, TAFT's benefits and drawbacks are debated due to conflicting reports. Thus, we conducted a prospective pilot randomized control trial to elucidate the impact of TAFT on postoperative outcomes and the potential benefits of avoidance of TAFT. MethodsWe performed a single-center randomized controlled trial in 53 neonates diagnosed with Type C EA/TEF who were operated on from January 2022 to June 2023. The patients were randomized into TAFT (n = 30) and non-TAFT (n = 23) groups. The patients were followed up for a minimum of 6 months following discharge. The primary objective of the study was to compare the rate of anastomotic leaks following primary repair of EA/TEF in both groups. Secondary objectives included early postoperative outcomes such as the occurrence of anastomotic stricture, time taken to initiate feeding, the time required to reach full feeding, the incidence of brief resolved unexplained events (BRUE) or acute life-threatening events (ALTE), the incidence of gastroesophageal reflux (GER), somatic growth, and all-cause mortality within 30 days post-surgery. ResultThe study demonstrated that TAFT placement was associated with a higher incidence of anastomotic leaks (20 % vs 0, p = 0.03). However, there was no difference in the 30-day mortality between both groups. Although the rate of anastomotic strictures and GER was higher in the TAFT group (54.5 % vs 27.8 %, p = 0.08 and 25 % vs 57.1 %, p = 0.076), it did not reach statistical significance. Avoiding TAFT resulted in earlier initiation of enteral feeding (18 vs 22 days, p = 0.002), shorter time to achieve full feeds (15 vs 21 days, p = 0.03), reduced duration of TPN (3 vs 10 days; p = 0.001), improved weight gain at the 2-week follow-up (27.5 vs. 24.4 g/kg/day, p-value = 0.037) and lesser incidence of ALTE/BRUE (11.1 % vs 48 %, p = 0.01) at 6 months. ConclusionWhile previous research has covered TAFT's impact on complications such as anastomotic leak, stricture, use of TPN and enteral feed, prospective randomized studies remain limited, and the impact on GER, somatic growth, and occurrence of ALTE/BRUE is still unexplored. This study evaluated the short-term outcomes of EA/TEF in a resource-challenged setting, shedding light on the potential benefits of repair without TAFT such as reduction in the rate of anastomotic leak, earlier feeding, reduced GER, better somatic growth and reduced incidence of ALTE/BRUE. Level of EvidenceLevel II (Treatment study/Randomized controlled trial).

Impact of Social Vulnerability, Race, and Urbanicity on Early Nutritional Outcomes in Patients With Cleft Palate.

Patients with cleft palate experience early feeding difficulties, resulting in increased hospital utilization due to poor nutritional status. Sociodemographic factors may impact access and outcomes for cleft patients. This study investigates the association of social vulnerability, race, and urbanicity on birth encounter metrics and failure to thrive (FTT) rates for patients with cleft palate. Retrospective data from 2013 to 2023 was queried from Cosmos, a national deidentified database from Epic electronic health record. Birth metrics, the prevalence of FTT, and MyChart activation rates were compared across sociodemographic cohorts based on (1) social vulnerability index (SVI) quartiles, (2) patient race, and (3) USDA Rural-Urban Commuting Area (RUCA) codes using χ2 or Fisher exact tests. There were 92,437 patients diagnosed with cleft palate. Birth weight was lower in socially vulnerable and Black patients (SVI 75%: 101.50±1.57oz; SVI 25%: 106.40±1.85oz; Black: 95.3±2.63oz; White: 104.90±1.02oz; Other: 104.80±2.09oz), and length of stay was longer (SVI 75%: 21±2.39d; SVI 25%: 15±2.18d; Black: 22±4d). FTT related admissions increased with SVI quartile (Q25: 0.19%; Q25-50; 0.29%, Q50-75: 0.34%; Q75: 0.47%; P<0.001). An opposite trend was observed for MyChart activation rates (P<0.001). High SVI and Black patients are susceptible to unfavorable nutritional outcomes. Access disparities, such as direct-to-provider communication systems (ie, MyChart), may contribute. Awareness of social identities, geography, and community may assist in providing individualized care in early life.

Impact of early weaning and nutritional interventions on growth performance, digestive metabolism, and serum biomarkers in lambs: A biomechanical perspective

The aim of this study was to investigate the effects of early weaning and nutritional interventions on growth performance, nutrient digestion and metabolism, and serological indices of hu sheep lambs, with a view to providing a basis for the feasibility of early weaning of hu sheep lambs under conditions of supplemental milk replacer. Ninety neonatal hu sheep lambs were weaned at 21 days (n = 60) (divided into two groups: early weaned, EW; and resveratrol-fed, RSV) as well as 49 days (n = 30) (control group, CON) weaning, and the trial period was 90 days. The results showed that: 1) there was no significant difference (P &gt; 0.05) in the initial and final weights of the lambs, and the average daily gain (ADG) of the EW and RSV groups was significantly lower than that of the CON group (P &lt; 0.05) from 31 to 45 days of age. Early weaned lambs were more susceptible to weaning stress compared to late weaned lambs and the effect of nutritional intervention (feeding resveratrol) on lamb growth performance was not significant. 2) The apparent digestibility of crude protein (CP) in the experimental group was significantly lower than that of the control group (P &lt; 0.05), and the nitrogen intake, net protein utilization and protein biological value indexes of lake lambs in the experimental group were significantly different from those of the control group (P &lt; 0.05). 3) Early feeding of resveratrol was not significant in improving the digestive metabolism of nutrients. 4) Early weaning as well as the addition of resveratrol had a significant effect on the serum GLU and TC indexes of the lambs (P &lt; 0.05), but did not show a significant effect on any of the other indexes.