Early Initiation Of Enteral Feeding Research Articles

Enteral Feeding Dilemmas: Navigating the Impact of Bacterial Contamination in Hospitalized Populations

Introduction: Enteral feeding is essential for hospitalized patients unable to consume oral nutrition. However, it poses a risk of bacterial contamination, leading to infections and increased morbidity and mortality. Method: Studies have shown that contaminated enteral feeds are associated with longer hospital stays and worsened patient outcomes. Common pathogens include Gram-negative bacilli (e.g., Serratia spp., Klebsiella spp., Enterobacter spp.), coagulase-negative staphylococci, and Clostridium difficile. Preventing contamination requires identifying and mitigating potential routes. This comprehensive approach encompasses careful practices during production, storage, preparation, and administration of enteral feeds. Result: Early initiation of enteral feeding has also been linked to lower infection rates. Standardized protocols, hand hygiene adherence, routine monitoring for infection signs, and ongoing staff education are crucial for safe enteral feeding. Further research is needed to better understand risk factors for contamination and evaluate the effectiveness of preventive interventions. Conclusion: Addressing these knowledge gaps can significantly improve the quality of enteral feeding and reduce infection burden in hospitalized patients.

Comparison of laparoscopic and open simultaneous surgeries for synchronous metastases of colorectal cancer in the liver: meta-analysis

Aim. To analyze studies focused on comparing laparoscopic and open simultaneous surgeries for synchronous metastases of colorectal cancer in the liver.Materials and methods. The electronic databases PubMed, Web of Science, Scopus, Embase, Cochrane Library were searched for the studies focused on the comparison of open and laparoscopic simultaneous surgeries for synchronous metastatic liver lesions, dated till October 20, 2020. Keywords: simultaneous resections, colorectal cancer, liver metastases, simultaneous laparoscopic.Results. Meta-analysis contains the results of 1211 simultaneous surgeries for simultaneous metastases of colorectal cancer in the liver: 450 laparoscopic and 761 open surgeries. Laparoscopic surgery was characterized with lower blood loss [weighted mean difference (WMD) = -131.77, 95% CI: -232.54 to -31.00, p = 0.01], a shorter postoperative hospitalization [WMD = -2.87, 95% CI: -3.41 to -2. 33, p < 0.00001], early first bowel movement [WMD = -0.99, 95% CI: -1.40 to -0.58, p < 0.0001], early initiation of enteral feeding [WMD = -1.20, 95% CI: -2.06 to -0.33, p = 0.007]), lower incidence of postoperative complications [OR = 0.60, 95% CI: 0.46–0.80, p = 0.0004]. A statistically significant advantage of laparoscopic access was established in overall [OR = 0.80, 95% CI: 0.64–0.99, p = 0.04] and recurrence-free survival [OR = 0.73, 95% CI: 0.60–0.89, p = 0.002].Conclusion. Perioperative and distant oncologic outcomes demonstrate safety and efficacy of laparoscopic simultaneous interventions for synchronous metastases of colorectal cancer in comparison with open interventions.

Effect of early initiation of enteral nutrition on short-term clinical outcomes of very premature infants: A national multicenter cohort study in China

ObjectivesThe management of enteral nutrition in very preterm infants (VPIs) is still controversial, and there is no consensus on the optimal time point after birth at which enteral nutrition can be started. The aim of this study was to investigate the effect of early initiation of enteral nutrition on the short-term clinical outcomes of VPIs. MethodsData of infants (n = 2514) born before 32 wk of gestation were collected from 28 hospitals located in seven different regions of China. Based on whether enteral feeding was initiated within or after 24 h since birth, the infants were divided into an early initiation of enteral feeding (EIEF) group and a delayed initiation of enteral feeding (DIEF) group. ResultsCompared with the DIEF group, the EIEF group was more likely to tolerate enteral nutrition and had less need for parenteral nutrition (all P < 0.05). The EIEF group was associated with lower incidence rates of feeding intolerance, extrauterine growth restriction (EUGR), and late-onset sepsis (LOS) (all P < 0.05). There was no significant difference in the incidence of necrotizing enterocolitis (NEC) (Bell stage ≥2) between the two groups (P = 0.118). The multivariate logistic regression analysis revealed that EIEF was a protective factor against EUGR (odds ratio [OR], 0.621; 95% confidence interval [CI], 0.544–0.735; P < 0.001), feeding intolerance (OR, 0.658; 95% CI, 0.554–0.782; P < 0.001), and LOS (OR, 0.706; 95% CI, 0.550–0.906; P = 0.006). ConclusionsEarly initiation of enteral feeding was associated with less frequency of feeding intolerance, EUGR, and LOS, and it may shorten the time to reach total enteral feeding without increasing the risk of NEC.

Evidence-Based Practices Reduce Necrotizing Enterocolitis and Improve Nutrition Outcomes in Very Low-Birth-Weight Infants.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants. Survivors may suffer both short- and long-term morbidities. Current evidence suggests that the incidence of NEC can be reduced by standardizing the care delivery in addressing key risk factors including an altered gut microbiome, use of formula milk, hyperosmolar feeds, and unrestricted use of high-risk medications METHODS: Since 2014, the department has a workgroup who analyzed all cases of NEC within a month of diagnosis to identify preventable risk factors. Existing evidence-based quality improvement strategies were revised and new ones were implemented sequentially over the next 4 years. These strategies include (1) a standardized feeding protocol, (2) early initiation of enteral feeding using human milk, (3) optimization of the osmolality of preterm milk feeds using standardized dilution guidelines for additives, and (4) promotion of healthy microbiome by use of probiotics, early oral care with colostrum and by restricting high-risk medications and prolonged use of empirical antibiotics RESULTS: Baseline characteristics of the patients including sex, gestational age, and birth weight were similar during the study period. After implementing the evidence-based practices successively over 4 years, the incidence of NEC in very- low birth-weight (VLBW) infants dropped from 7% in 2014 to 0% (P < .001) in 2018. The duration of parenteral nutrition, use of central line, and days to full feeds were also reduced significantly (P < .05) CONCLUSION: Adopting evidence-based best practices resulted in a significant decrease in the incidence of NEC and improved the nutrition outcomes in VLBW infants.

Historical Perspectives: Low Birthweight and Preterm Infants in Indonesia.

The incidence of infants with low birthweight (LBW), prematurity, and small for gestational age (SGA) in Indonesia remains high, and the morbidity and mortality in these infants are significant. To study these groups of infants in Indonesia, the author searched PubMed/Medline, the Cochrane Library, Google, Indonesian reports, local publications, and doctoral and master theses in English and Indonesian from 1987 to February 2019. In this review, the development of local reference growth charts of infants born in Indonesia is described, as well as the importance of these curves in defining the prevalence of SGA infants. Some of the risk factors associated with LBW, preterm, and SGA Indonesian infants are described. The author also discusses the effectiveness of specific interventions, such as kangaroo mother care, early initiation of enteral feedings, increased breastfeeding rates, and identifying the optimal timing of hospital discharge. Some of the morbidities associated with LBW infants born in Indonesia are described. Advances in hospital care and postdischarge follow-up of LBW, preterm, and SGA infants born in Indonesia are critical to decrease the morbidity and mortality rates associated with these populations.

Turkish Neonatal Society guideline on enteral feeding of the preterm infant.

Early initiation of enteral feeding with the own mother’s milk and prevention of postnatal growth failure is the target of nutrition in preterm infants. Together with total parenteral nutrition, mouth care and minimal enteral nutrition is started with colostrum in the very early hours of life in small preterm infants. Expressed mother’s milk is given via a gastric tube and gradually increased in accordance with the gestational age/birth weight and the risk factors. For infants born heavier than 1 000 grams, the aim is to reach total enteral feeding at the end of first week, and at the end of the second week for infants weighing less than 1000 grams. Supporting mothers in milk expression and kangaroo mother care, promoting non-nutritive feeding, appropriate fortification of mother’ milk, and initiating and advancing breastfeeding as soon as the infant is ready are all crucial. Donor mother milk, and as a second choice, preterm formula is advised if the mother’s milk is not available. Individualized post-discharge nutrition decisions can be taken in accordance with the actual growth at the time of discharge. The goal is optimal neurodevelopmental achievement together with the prevention of long-term metabolic problems. Late preterm infants, which constitute the majority of preterm infants, also need close nutritional attention and follow-up.

Incidence and risk factors associated with hypoglycemia in the first 48 hours of life in Small for Gestational Age Neonates

Background: Hypoglycemia is one of the important problems encountered in small for gestational age (SGA) neonates. The incidence and risk factors associated with hypoglycemia in the first 48 hours of life in Small for Gestational Age (SGA) Neonates was investigated in this study.Methods: Capillary Blood Glucose was screened by glucostix at 1, 2, 6, 12, 24, and 48 hours of age in 100 SGA neonates fulfilling the inclusion and exclusion criteria.Results: The overall incidence of hypoglycemia in SGA neonates in the study was 24%. The incidence of hypoglycemia was significantly higher in preterm SGA neonates (37.50%) when compared to term SGA neonates (17.65%). The incidence of symptomatic hypoglycemia was 9%. Maximum incidence of hypoglycemia was noted at 2 hours of life. Of the 24 SGA neonates with hypoglycemia, 33.33% had one episode of hypoglycemia, 45.83% had two episodes of hypoglycemia, 12.50% had three episodes of hypoglycemia, 8.33% had four episodes of hypoglycemia. None of the SGA neonate had more than four episodes of hypoglycemia. Early initiation of enteral feeding was significantly associated with decreased incidence of hypoglycemia in SGA neonates. There was no significant correlation between incidence of hypoglycemia in SGA neonates and gender of the baby, parity of mother, mode of delivery and type of IUGR.Conclusions: It is recommended to monitor all SGA neonates especially preterm SGA for hypoglycemia and ensure early initiation of enteral feeding in all SGA neonates.

Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas.

Subdural hematomas (SDH) represent common neurosurgical problem associated with significant morbidity, mortality, and high recurrence rates. SDH incidence increases with age; numbers of patients affected by SDH continue to rise with our aging population and increasing number of people taking antiplatelet agents or anticoagulation. Medical and surgical SDH management remains a subject of investigation. Initial management of patients with concern for altered mental status with or without trauma starts with Emergency Neurological Life Support (ENLS) guidelines, with a focus on maintaining ICP < 22mmHg, CPP > 60mmHg, MAP 80-110mmHg, and PaO2 > 60mmHg, followed by rapid sequence intubation if necessary, and expedited acquisition of imaging to identify a space-occupying lesion. Patients are administered anti-seizure medications, and their antiplatelet medications or anticoagulation may be reversed if neurosurgical interventions are anticipated, or until hemorrhage is stabilized on imaging. Medical SDH care focuses on (a) management of intracranial hypertension; (b) maintenance of adequate cerebral perfusion; (c) seizure prevention and treatment; (d) maintenance of normothermia, eucarbia, euglycemia, and euvolemia; and (e) early initiation of enteral feeding, mobilization, and physical therapy. Post-operatively, SDH patients require ICU level care and are co-managed by neurointensivists with expertise in treating increased intracranial pressure, seizures, and status epilepticus, as well as medical complications of critical illness. Here, we review various aspects of medical management with a brief overview of pertinent literature and clinical trials for patients diagnosed with SDH.

Nutrition is Critical.

Are they hungry?” is a frequent concern expressed by friends and family members in regard to patients receiving mechanical ventilation in the intensive care unit (ICU). Although the question seems to focus on patients’ comfort, we know that nutrition in critical illness plays a key role in patients’ outcomes. The 2016 clinical guidelines on nutrition support therapy from the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine (ASPEN-SCCM) include a recommendation for the early initiation of enteral feeding in critically ill adults who are unable to eat. Enteral feeding is a cost-effective strategy for preventing malnutrition, a common complication in acute care, and has the added benefits of maintaining the gastrointestinal tract’s integrity and promoting immune function. The study by Vest et al, showing that patients who had an order for enteral nutrition had a lower risk of death regardless of their body mass index, is further evidence of the value of enteral feeding.Although addressing nutrition is an intraprofessional responsibility, the implementation of enteral feeding relies on nursing expertise. Nurses assess patients’ tolerance of feedings, make decisions about feeding interruptions, and intervene to maintain feeding tube patency. By ensuring that these actions are aligned with current evidence, we deliver care that promotes the best possible outcomes for our patients and, might, at the same time, ease any concern about the discomfort of hunger.

Meeting the nutritional needs of premature babies: their future is in our hands.

The goals of early nutrition in preterm infants are to provide all the necessary vital nutrients, achieve extra-uterine growth rates similar to fetuses of the same gestational age, and support functional neurodevelopmental outcomes that are comparable to those of infants born at term. It is vital to provide nutrition that will maximally support brain growth and development, but over-feeding with accelerated growth, fat accumulation and long-term metabolic consequences should also be avoided. Because the morbidity associated with prematurity increases nutritional and energetic demands, the basic approach is of providing early intensive nutrition. Protein is the main driving force for growth and brain development. Since deficits in protein occur from the first day of extra-uterine life, sufficient quantities of parenteral amino acids should be provided from the first hours of life. With protein and carbohydrates, enough energy should also be provided, via concomitant early administration of intravenous lipid emulsions. Early initiation of enteral feeding with advancement to full enteral nutrition is associated with better maturation of the gut and better neuro-developmental outcomes. Human milk is the best food for preterm babies, although enrichment may be needed.

Early Nutrition for Preterm Babies

Every year, 15 million babies are born too soon. Many preterm babies now survive and grow up to have normal lives, but the smaller they are, the greater the challenges in establishing milk feeds. Nutrition for these tiny babies is critically important: they are born at a time when the brain is undergoing the most rapid growth of any time during life. Inadequate nutrition results in poor growth, including poor brain growth, and this is associated with poorer long-term neurodevelopmental outcomes. Unfortunately, faltering postnatal growth is the norm for many of these vulnerable babies, largely due to the difficulties in providing adequate protein intake in the first fewdays after birth. This results in an accumulating nitrogen deficit that is difficult to rescue. There are some relatively simple nutritional strategies that can be used to improve early protein intake, including concentrated standardized intravenous nutrition solutions commenced as soon as possible after birth, early initiation of enteral feeding with more rapid advancement of feeds as tolerated, early use of human milk fortifiers, and higher target feed volumes. We have shown through observational studies that using these strategies achieves currently recommended protein intakes in early life and prevents the downward crossing of centiles for weight that are almost universally reported for extremely-low-birth-weight babies. However, high-quality randomized controlled trials with a clinically important primary outcome are required to address definitively the role of higher protein nutrition in early life on long-term outcome. Such a trial currently is recruiting in New Zealand and should report within 5 years, with survival free of neurodisability at 2 years of age as themain outcome variable. Nutr Today. 2015;50(5):230Y239

Got milk? Effects of early enteral feedings in patients with gastroschisis.

Initiating early enteral intake post-surgical gastroschisis repair may result in better patient outcomes. However, there is lack of evidence and consistency in clinical practice regarding the timing of initiation of feedings, and few studies have determined best practices for post-operative nutritional management. To determine whether early nutritional management using a standardized advancement protocol improves outcomes for patients with gastroschisis. A retrospective study was used, following the implementation of a new early enteral feeding protocol. Patients managed without the new protocol, from January 2007 through December 2009, formed the traditional feeding group, while those receiving post-protocol nutritional management, from January 2010 through December 2012, comprised the early enteral feeding group. The main outcome, measured by length of stay (LOS), and secondary outcomes, including incidence of sepsis, were evaluated; N = 32. There was a statistically significant difference in the scores for LOS (P = .022) and incidence of sepsis (P = .36). No correlation was found between the number of days to initial feeding and LOS (P = .732). However, there was a robust, positive correlation between the number of days to achieve full feedings and LOS (P < .001) IMPLICATIONS FOR PRACTICE: These findings support the benefit of early initiation of enteral feedings in reducing the incidence of sepsis. Furthermore, they suggest the time to achieve full enteral feedings, not necessarily the timing of initiation of feedings, significantly impacts LOS. Consideration for future studies include incorporating strategies that combine early enteral feeding initiatives with interventions that allow for quicker onset of full enteral intake.

Electromagnetic Sensor-Guided Enteral Access Systems: A Literature Review.

Enteral feeding is the nutritional support of choice for acutely ill patients with functional gastrointestinal tracts who are unable to swallow. Several benefits including reduced mortality and length of hospital stay have been associated with early initiation of enteral feeding. However, misplacement of conventional nasoenteric tubes is relatively common and can result in complications including pneumothorax. In addition, the need to confirm the position by X-ray can delay the start of using the tube. Eliminating these delays can help patients start feeding, and minimise the adverse impact on initiating hydration and medication. The purpose of this review was to critically examine whether electromagnetic sensor-guided enteral access systems (EMS-EAS) can help overcome the challenges of conventional nasoenteric feeding tube placement and confirmation. The Royal Society of Medicine’s library performed two searches on Medline (1946–March 2014) and Embase (1947–March 2014) covering all papers on Cortrak or electromagnetic or magnetic guidance systems for feeding tubes in adults. Results from the literature search found an agreement between the radiographic and EMS-EAS confirmation of placement. EMS-EAS virtually eliminated the risk of misplacement and pneumothorax was not reported. In addition, studies showed a small decrease in the number of X-rays with EMS-EAS and a reduced average time to start feeding compared with blind placement. This review suggests that EMS-EAS reduces several complications associated with the misplacement of nasoenteric feeding tubes, and that there could be considerable improvements in mortality, morbidity, patient experience and cost if EMS-EAS is used instead of conventional methods.

Physical activity level is impaired and diet dependent in preterm newborn pigs.

Preterm infants show delayed development of motor function after birth. This may relate to functional immaturity of many organs, including the gut and brain. Using pigs as model for preterm infants, we hypothesized that early initiation of enteral feeding stimulates both gut growth and neonatal physical activity. In experiment 1, preterm and term pigs were fed parenteral nutrition (PN) or PN plus bovine colostrum (BC, 16-64 ml/kg/d enterally) for 5 d. In experiment 2, preterm pigs were fed PN+BC or PN+formula for 5 d. In experiment 3, preterm pigs were fed BC, formula, or human milk (HM) for 10 d. Incubator home cage activity (HCA) was quantified by continuous camera recordings. Preterm birth was associated with reduced intestinal weight and HCA (experiment 1), and BC or formula supplementation increased intestinal weights and HCA (experiments 1+2). Enteral BC and HM feeding increased HCA, intestinal weights, and necrotizing enteritis resistance, relative to formula (experiment 3). Preterm pigs show decreased physical activity, and the first enteral feeds diet dependently stimulate both gut growth and physical activity. The effects may arise from maturation of digestive, metabolic, and neurological functions, including gut serotonin production, by the first enteral feeds and milk bioactive factors.

PO-0471 Neonatal Arousal And Home-cage Activity Are Feeding-dependent In Preterm Pi

Background and aims Preterm infants exhibit delayed neonatal arousal and impaired motor function. Impaired neuromuscular development, probably interacting with gut and metabolic dysfunctions, may explain this. Using preterm pigs as models, we hypothesised that early initiation of enteral feeding stimulates both gut growth and neonatal arousal and physical activity. Methods Experiment 1: Caesarean-delivered preterm and term pigs were fed parenteral nutrition (PN) or PN plus enteral bovine colostrum (BC) for five days. Other preterm pigs were fed PN with or without BC or formula for five days (Experiment 2), or increasing doses of BC, formula or human milk (HM) for 10 days (Experiment 3). Daily energy intake was matched among the groups in each experiment and home cage activity (HCA) was recorded by continuous camera surveillance. Results Prematurity at birth delayed eye lid opening, first stand and walk, and reduced relative intestinal weight and HCA (Experiment 1, all p Conclusions Prematurity decreased physical activity and relative gut weight within the first week after birth. Small volumes of enteral feeds increased the activity. This may result from general metabolic effects of enteral feeding but could also reflect a direct diet-dependent, gut-neuromuscular maturation in preterm neonates fed enterally. The results support the importance of early enteral feeding of preterm infants with adequate amounts of an optimal diet.

Early Initiation of Enteral Feeding in Cancer Patients after Outpatient Percutaneous Fluoroscopy-Guided Gastrostomy Catheter Placement

PurposeTo report the results of early enteral feeding in patients with cancer after outpatient placement of a percutaneous fluoroscopy-guided gastrostomy (PFG). Materials and MethodsFrom January 2008 through December 2008, 121 consecutive patients with cancer underwent outpatient placement of a PFG for nutrition. Of these patients, 118 patients met criteria for early feeding, and 113 were successfully fed early (after at least 3 hours). Of the patients fed early, 5 had insufficient follow-up for further analysis leaving 108 patients for outcomes analysis. After placement of the PFG, patients were put on low-wall suction via the PFG for 1 hour followed by feeding via the PFG at least 3 hours after placement. Follow-up evaluation was done the next business day. The medical records were reviewed for 30-day outcomes of early feeding, technical aspects of the procedures, and complications. ResultsAfter placement of the PFG, 98% (118 of 121) of patients met criteria for early feeding, and 93% (113 of 121) of patients were successfully fed early. The median time between the end of the procedure and initiation of feeding was 4 hours (interquartile range, 3.7–4.4 h). The 30-day minor complication rate was 14% (15 of 108), and the 30-day major complication rate was 1% (1 of 108). No complications were directly attributable to early feeding. ConclusionsEarly initiation of tube feedings after outpatient placement of a PFG was well tolerated in patients with cancer and carried comparable risks to previously reported results using traditional delayed feeding protocols. Early feeding provided patients with prompt enteral nutrition and eliminated the need for routine hospital admission after the procedure.

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program.

Short bowel syndrome develops when the remnant mass of functioning enterocytes following massive resections cannot support growth or maintain fluid-electrolyte balance and requires parenteral nutrition. Resection itself stimulates the intestine's inherent ability to adapt morphologically and functionally. The capacity to change is very much related to the high turnover rate of enterocytes and is mediated by several signals; these signals are mediated in large part by enteral nutrition. Early initiation of enteral feeding, close clinical monitoring, and ongoing assessment of intestinal adaptation are key to the prevention of irreversible intestinal failure. The length of the functional small bowel remnant is the most important variable affecting outcome. The major objective of intestinal rehabilitation programs is to achieve early oral nutritional autonomy while maintaining normal growth and nutrition status and minimizing total parenteral nutrition related comorbidities such as chronic progressive liver disease. Remarkable progress has been made in terms of survivability and quality of life, especially in the context of coordinated multidisciplinary programs, but much work remains to be done.

Post‐transplant critical care outcomes for pediatric multivisceral and intestinal transplant patients

This study reviews the post-operative management of pediatric intestinal transplant patients at a single center with reporting of standard PICU benchmarks for quality of care. It is a retrospective, descriptive, chart review describing our institution's experience between 2006 and 2010. Twenty patients were included. Median age at transplant was 1.6 yr. Median length of PICU stay was 12 days. Median ventilation time was two days. Median time for continuous sedation infusion was two days, with median continuous pain medication infusion of three days. All patients were placed on parental nutrition and started on enteral feedings between days 3 and 4. Forty percent of patients required hemodynamic support. Only 35% of patients required insulin therapy. Diuretics were frequently used in this patient population. There were no episodes of early rejection. The survival rate to PICU discharge was 95%. Our institution's experience over the past four yr has been very successful with a short duration of mechanical ventilation, limited use of pain and sedation drips, early initiation of enteral feedings, minimal hemodynamic support, and a low mortality rate to PICU discharge despite a preponderance of complex MVTx recipients.

Gastroschisis—antenatal diagnosis

Improved post-operative outcomes following gastroschisis repair are attributed to advancement in perioperative and post-operative care and early enteral feeding. This study evaluates the role of standardized postoperative feeding protocols in gastroschisis.A systematic review and meta-analysis of studies published from January 2000 to April 2019 in MEDLINE, EMBASE, Cochrane Library databases and Google Scholar was conducted. Primary outcomes were duration to full enteral feeding and cessation of parenteral nutrition. Secondary outcomes included days to first enteral feeding, length of stay, compliance, complication and mortality rates. Meta-analysis was done using the RevMan Analysis Statistical Package in Review Manager (Version 5.3) using a random effects model and reported as pooled Risk Ratio and Mean Difference. p-value < 0.05 was considered statistically significant.Eight observational cohort studies were identified and their data analyzed. Significant heterogeneity was noted for some outcomes. Standardized feeding protocols resulted in fewer days to first enteral feeding by 3.19 days (95% CI: -4.73, -1.66, p < 0.0001) than non-protocolized feeding, less complication rates, reduced mortality and better compliance to care. The duration of parenteral nutrition and time to full enteral feeding were not significantly affected.Protocolized feeding post-gastroschisis repair is associated with early initiation of enteral feeding. There is a likelihood of reduced rates of sepsis; shorter duration of parenteral nutrition, length of hospital stay and time to full enteral feeding. However, the latter trends are not statistically significant and will require further studies best accomplished with a prospective randomized trial or more cohort studies.

A new technique for bedside placement of enteral feeding tubes: a prospective cohort study

IntroductionTo accomplish early enteral feeding in the critically ill patient a new transnasal endoscopic approach to the placement of postpyloric feeding tubes by intensive care physicians was evaluated.MethodsThis was a prospective cohort study in 27 critically ill patients subjected to transnasal endoscopy and intubation of the pylorus. Attending intensive care physicians were trained in the handling of the new endoscope for transnasal gastroenteroscopy for two days. A jejunal feeding tube was advanced via the instrument channel and the correct position assessed by contrast radiography. The primary outcome measure was successful postpyloric placement of the tube. Secondary outcome measures were time needed for the placement, complications such as bleeding and formation of loops, and the score of the placement difficulty graded from 1 (easy) to 4 (difficult). Data are given as mean values and standard deviation.ResultsOut of 34 attempted jejunal tube placements, 28 tubes (82%) were placed correctly in the jejunum. The duration of the procedure was 28 ± 12 minutes. The difficulty of the tube placement was judged as follows: grade 1: 17 patients, grade 2: 8 patients, grade 3: 7 patients, grade 4: 2 patients. In three cases, the tube position was incorrect, and in another three cases, the procedure had to be aborted. In one patient bleeding occurred that required no further treatment.ConclusionsFast and reliable transnasal insertion of postpyloric feeding tubes can be accomplished by trained intensive care physicians at the bedside using the presented procedure. This new technique may facilitate early initiation of enteral feeding in intensive care patients.