Early Tube Feeding Research Articles

Factors Associated with Growth in a Cohort of Children with Complex Biventricular Congenital Heart Disease

ObjectivesTo evaluate patterns and determinants of longitudinal growth among children requiring complex biventricular repair for congenital heart disease, and to assess for associations of growth with early feeding modality, comorbidities, postoperative complications, and socioeconomic characteristics. Study DesignA single-institution retrospective cohort study was performed in children born 2/1999-3/2009 with complex congenital heart disease who underwent biventricular repair before age 4, defined by Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) category 3-5. Clinical characteristics, height, weight, and body mass index (BMI) from ages 2-12 were collected by chart review. Neighborhood-level socioeconomic data were identified using a geographic information system approach. The adjusted association of covariates with growth outcomes was estimated using multivariable linear regression models using generalized estimating equations. ResultsCompared with population growth curves, the cohort (n = 150) trended toward early decrease in age-adjusted weight and height. Early tube feeding was significantly associated with decreased BMI prior to adolescence (-0.539; 95% CI -1.02, -0.054; p = 0.029). Additionally, other clinical and perioperative characteristics had significant associations with growth, including low birthweight, preoperative tube feeds, need for multiple bypass runs, and diagnosis of feeding disorder. ConclusionsEarly childhood growth in children with complex biventricular repair may be impaired. Early tube feeding was associated with decreased BMI over the course of early childhood, which may indicate a need for continued close nutrition follow-up and support even beyond the duration of tube feeds.

Early Tube Feeding Improves Nutritional Outcomes in Children with Neurological Disabilities: A Retrospective Cohort Study.

Tube feeding is a life-saving treatment for children with neurological disabilities (ND), who often suffer from malnutrition and feeding disorders. Nonetheless, it is still not widely used. Our aim was to evaluate the outcomes of exclusive tube feeding in a cohort of ND children. All consecutive ND children who started tube feeding at our center within the last 5 years were included in this retrospective study. Weight-for-age, body mass index (BMI), mid-upper arm circumference (MUAC) Z-scores, and symptoms were collected at baseline (V0), 6 (V1), and 12 months (V2) after gastrostomy placement. Fifty children (62% males) were included. The ND-underlying disease was genetic (n = 29, 58%), hypoxic-ischemic encephalopathy (n = 17, 34%), or metabolic (n = 4, 8%). Indications for tube feeding were malnutrition (n = 35, 70%), recurrent respiratory infections (n = 11, 22%), or both (n = 4, 8%). Enteral formulae were polymeric (n = 29, 58%), semi-elemental (n = 17, 34%), hypercaloric (n = 3, 6%), or elemental (n = 1, 2%). Homemade blended feed was offered to three children (6%) in addition to the formula. Weight and BMI increased over the study period. Except for constipation, all symptoms (cough, vomiting, and diarrhea) improved at 6 and 12 months (p < 0.05). Non-serious complications (n = 8; track disruption, granuloma, and skin infection) were observed. Longer disease duration (p < 0.001) at the start of tube feeding was associated with the absence of normalization of nutritional status (BMI Z-score > 2 SD) at 12 months. Tube feeding with commercially available enteral formulae should be started as early as possible for better outcomes.

Early Tube Feeding after Percutaneous Endoscopic Gastrostomy (PEG): An Observational Study.

This study investigated whether enteral nutrition by early tube feeding led to changes in clinical parameters compared to tube feeding after 24 h. Starting on 1 January 2021, and following the latest update of the ESPEN guidelines on enteral nutrition, patients with percutaneous endoscopic gastrostomy (PEG) received tube feeding 4 h after tube insertion. An observational study was conducted to analyze whether the new scheme affected patient complaints, complications, or hospitalization duration compared to the previous procedure of tube feeding starting after 24 h. Clinical patient records from one year before and one year after the introduction of the new scheme were examined. A total of 98 patients were included, and of those 47 received tube feeding 24 h after tube insertion, and 51 received tube feeding 4 h after tube insertion. The new scheme did not influence the frequency or severity of patient complaints or complications related to tube feeding (all p-values > 0.05). However, the study showed that the length of stay in hospital was significantly shorter when following the new scheme (p = 0.030). In this observational cohort study an earlier start of tube feeding did not produce any negative consequences but did reduce the duration of hospitalization. Therefore, an early start, as suggested in the recent ESPEN guidelines, is supported and recommended.

Abstract NS8: Predictors Of Complete Oral Feeding Resumption After Stroke Based On The Modified Volume-viscosity Swallow Test In A Rehabilitation Hospital

Objective: Although the importance of early tube feeding after stroke has been established, many risks and problems such as negative impacts on swallow function, respiratory infections and feeling uncomfortable, also warrant attention. The trajectory of swallowing function recovery may be related to each patient’s characteristics. There is still no systematic predictors for clinical decision-making regarding oral feeding resumption. The aim is to explore predictors of complete oral feeding resumption after feeding tube with stroke based on the modified V-VST. Methods: A total of 86 stroke patients with tube feeding were enrolled after admission in rehabilitation hospital from 2020 to 2021. The swallowing function was screened with modified V-VST. If a patient complete every viscosity more than 5ml, feeding tube will be removed. Oral feeding was begun using mechanical soft diet and thickener to ensure every meal safe. 55 patients(63.95%) resumed complete oral intake, while 31 patients(36.05%) presented a more permanent way of tube feeding. We compared the baseline and clinical characteristics between the groups. To analyze oral feeding resumption probability, the Kaplan-Meier method was used. Results: The days of onset to rehabilitation hospital admission was significantly shorter in the complete oral resumption group(20.89±11.27 vs 37.16±27.37; P&lt;0.001). The group was also measured better performance in activities of daily living (Barthel Index). Patients in the tube feeding group have high rate of previous stroke. Kaplan-Meier estimated oral feeding resumption rates, patients with longer days(&gt;21days) tolerated tube feeding longer.(P&lt;0.001). Conclusion: Days of onset to rehabilitation hospital was the strongest predictor of complete oral feeding resumption. Patients might benefit from early recovery in rehabilitation hospital and start oral intake as early as possible.

Comparison of nutritional effectiveness and complication rate between early nasojejunal and nasogastric tube feeding in patients with an intracerebral hemorrhage

BackgroundThis study aimed to compare nutritional effectiveness and complication rate between early nasojejunal and nasogastric tube feeding in patients with an intracerebral hemorrhage. MethodsThis was a retrospective study. Eighty patients with an intracerebral hemorrhage were divided into a nasojejunal and a nasogastric tube feeding group. Feeding tubes were placed within 6 h after admission, and enteral feeding began within 2 h after tube placement. The nutritional status and complication rate of the 2 groups were compared before and 2 and 4 weeks after beginning feeding. ResultsSerum prealbumin, serum albumin, and hemoglobin levels were significantly higher in the nasojejunal tube feeding group than in the nasogastric tube feeding group at 2 and 4 weeks after beginning feeding (all, p < 0.05). The incidence of gastric retention, pulmonary aspiration, and pneumonia were lower in the early nasojejunal tube feeding group than in the early nasogastric tube feeding group (all, p < 0.05). There was no significant difference in the incidence of diarrhea between the 2 groups. ConclusionCompared with early nasogastric feeding, early nasojejunal feeding provides better nutritional effectiveness and a lower incidence of gastric retention, pulmonary aspiration, and pneumonia in patients with an intracerebral hemorrhage.

FRI534 - Impact of early nasogastric tube feeding after endotherapy for acute variceal bleeding in patients with cirrhosis : a randomized controlled trial

FRI534 - Impact of early nasogastric tube feeding after endotherapy for acute variceal bleeding in patients with cirrhosis : a randomized controlled trial

ASO Visual Abstract: Impact of Early Jejunostomy Tube Feeding on Clinical Outcome and Parameters of Body Composition in Esophageal Cancer Patients Receiving Multimodal Therapy

ASO Visual Abstract: Impact of Early Jejunostomy Tube Feeding on Clinical Outcome and Parameters of Body Composition in Esophageal Cancer Patients Receiving Multimodal Therapy

Impact of Early Jejunostomy Tube Feeding on Clinical Outcome and Parameters of Body Composition in Esophageal Cancer Patients Receiving Multimodal Therapy.

Malnutrition commonly affects patients with esophageal cancer and has the potential to negatively influence treatment outcomes. The aim of this study was to investigate the impact of early (preoperative) jejunostomy tube feeding (JTF) in nutritionally 'high risk' patients receiving multimodal therapy for esophageal cancer. Patients were selected to undergo early JTF during neoadjuvant chemoradiotherapy (nCRT) in accordance with European Society for Clinical Nutrition and Metabolism (ESPEN) and Enhanced Recovery after Surgery (ERAS®) Society guidelines. Clinical outcomes were compared with patients who received routine JTF from the time of esophagectomy. Body composition was determined from computed tomography (CT) images acquired at diagnosis, after nCRT, and ≥3months after surgery. In total, 81 patients received early JTF and 91 patients received routine JTF. Patients who received early JTF had lower body mass index (BMI; 26.1±4.6 vs. 28.4±4.9; p=0.002), greater weight loss, and worse performance status at diagnosis. Groups were otherwise well-matched for baseline characteristics. Rate of re-intubation (8.8% vs. 1.1%; p=0.027), pulmonary embolism (5.0% vs. 0.0%; p=0.046), and 90-day mortality (10.0% vs. 1.1%; p=0.010) were worse in the early JTF group; however, overall survival was equivalent for both the early and routine JTF groups (p=0.053). Wide variation in the degree of preoperative muscle loss and total adipose tissue loss was observed across the entire study cohort. Relative preoperative muscle and adipose tissue loss in patients with early and routine JTF was equivalent. In patients determined to be at 'high risk' of malnutrition, early JTF may prevent excess morbidity after esophagectomy with an associated relative preservation of parameters of body composition.

Nutrition in acute stroke management: food for thought

Nutrition is crucial in the management of patients with acute stroke. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar Clinical features putting patients at risk of malnutrition include dysphagia, impaired consciousness, perception deficits, and cognitive dysfunction. Being malnourished or at risk of malnutrition on admission to hospital after stroke is linked with poor functional outcomes and mortality, and worsening of nutritional status during the acute stage post-stroke is associated with similar adverse outcomes. 2 Dennis M Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003; 34: 1450-1456 Crossref PubMed Scopus (0) Google Scholar Therefore, guidelines dedicated to acute stroke care generally include nutritional management. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar , 3 Powers WJ Rabinstein AA Ackerson T et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50: e344-e418 Crossref PubMed Scopus (1816) Google Scholar , 4 Boulanger JM Lindsay MP Gubitz G et al. Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 6th edition, update 2018. Int J Stroke. 2018; 13: 949-984 Crossref PubMed Scopus (154) Google Scholar , 5 Burgos R Bretón I Cereda E et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr. 2018; 37: 354-396 Summary Full Text Full Text PDF PubMed Scopus (175) Google Scholar The guideline for the diagnosis and treatment of post-stroke dysphagia from the European Stroke Organization and European Society for Swallowing Disorders, for example, recommends early enteral nutrition via a nasogastric tube if sufficient oral nutrition is not possible. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar This recommendation relies mainly on the second substudy of the Feed or Ordinary Diet (FOOD) trial, in which 859 patients with dysphagia after stroke were randomly assigned to either early tube feeding or delayed feeding starting later than 7 days after random assignment. Allocation to early tube feeding was associated with a non-significant reduction in mortality by 5·8% (there were 182 deaths in 429 patients randomly assigned to early tube feeding vs 207 deaths in 430 patients in the delayed feeding group; p=0·09). There were no differences in other outcomes, including severe disability or death (339 of 429 patients in the early-feeding group vs 344 of 430 patients in the delayed feeding group; p=0·7), pneumonia (132 of 429 patients in the early-feeding group vs 133 of 430 patients in the delayed feeding group; p>0·9), and percutaneous endoscopic gastrostomy placement at follow-up (30 of 429 patients in the early-feeding group vs 23 of 430 patients in the delayed feeding group). 6 Dennis M Lewis S Cranswick G Forbes J FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol Assess. 2006; 10: 1-120 Crossref Google Scholar Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trialIn the early phase of severe stroke, modified full enteral nutrition or hypocaloric enteral nutrition did not significantly reduce the risk of a poor outcomes compared with full enteral nutrition over a 90-day period. Hypocaloric enteral nutrition might be associated with increased mortality compared with modified full enteral nutrition. Further studies are needed to investigate whether modified full enteral nutrition might be the optimal strategy. Full-Text PDF

Evaluation of early feeding through nasogastric tube in patients after cardiovascular surgery at the Hanoi Heart Hospital

Objectives: The goal of the study was to describle and understand the factors related to the nasogastric tube feeding in patients after cardio-vascular surgery. Methods: The study involved 100 consecutive patients who underwent cardio-vascular surgery at Hanoi Heart Hospital from April 1 to August 3, 2019..All subjects underwent assessed with the early feeding through nasogastric tube after 6 hours operation. Main results: The mean age of the patients was 54.4 ± 14.5 years old. The percentage of men were 48%, BMI &lt;18.5 were 25%, used inotropic drug were 46% and sedative were 27%. The incidence of patients with abdominal distension and vomiting were 13%. No complications related to early feeding. Factors related to the residual index were sedation and duration of mechanical ventilation. Conclusion: Early nasogastric tube feeding in patients after cardiac and vascular surgery is safe, feasible and feasible.

Early versus late tube feeding initiation after PEG tube placement: Does time to feeding matter?

Variation exists in the timing of tube feed initiation after percutaneous endoscopic gastrostomy (PEG) tube placement. The aim of our study was to review outcomes of early tube feed (ETF) versus late tube feed (LTF) initiation after PEG tube placement. We performed a retrospective review of all trauma patients who underwent PEG tube placement from 1/2014 to 12/2018. ETF was defined as initiation<24h and LTF>24h after placement. The primary outcome measure was feeding intolerance and secondary outcomes included post-operative complications. All statistical analyses were performed using standard statistical methods (e.g. Pearson's Chi-squared, Fisher's exact and Mann Whitney-U tests). There were 295 patients (164 ETF and 131 LTF) that received a PEG tube at our level 1 trauma center. There was no difference with feeding intolerance at 12h (5% vs. 4%; p=0.88), 24h (1% vs. 2%; p=1.00), and 48h (4% vs. 4%; p=1.00). There was no difference when comparing intolerance symptoms such as nausea and vomiting (1% vs. 2%; p=0.79), abdominal tenderness (2% vs. 3%; p=0.76), high gastric residuals (2% vs. 2%; p=1.00) and aspiration (0% vs. 2%; p=0.39). There was no difference when comparing post-operative complications (4% vs. 8%; p=0.21). Early tube feeding after PEG placement is safe and equivalent to late tube feeding in the adult trauma population. Future prospective studies are warranted to establish the optimal timing for initiation of tube feeds after PEG tube placement.

Early vs Late Tube Feeding Initiation after PEG tube Placement: Does Time to Feeding Matter?

Early vs Late Tube Feeding Initiation after PEG tube Placement: Does Time to Feeding Matter?

Early versus delayed feeding after placement of percutaneous endoscopic gastrostomy tube with safe anesthetic techniques

Objective To compare the safety of early (≤4 h) versus 24 h tube feeding after percutaneous endoscopic gastrostomy (PEG) tube placement and to determine the effectiveness of i.v. sedation combined with ultrasound-guided, left side transversus abdominis plane (TAP) block versus combination with local anesthetic (LA) infiltration for PEG placement. Background Tube feeding used to be delayed up to 24 h after PEG placement, but results from many randomized controlled trials revealed that there was no need for delaying the tube feeding. The procedure was earlier done with general anesthesia or i.v. sedation with LA infiltration, but the use of i.v. sedation with TAP block may be another option. Patients and methods This was a prospective randomized study including 60 patients, requiring long-term nutritional support, who underwent the PEG procedure at GIT Endoscopy Unit, Damanhour Teaching Hospital, El Beheira, Egypt; between August 2017 and March 2018. Patients were randomly allocated into two equal groups, in group A; early tube feeding (≤4 h) was done and performed with i.v. midazolam and propofol-based sedation combined with ultrasound-guided, left side TAP block, whereas in group B; delayed tube feeding (24 h postprocedure) was done and performed with i.v. midazolam and propofol-based sedation with LA infiltration. Results There were no statistically significant differences between both groups with respect to procedure-related or anesthesia-related complications. Conclusion Early tube feeding (≤4 h) after PEG placement may be a safe option to delayed (24 h postprocedure) feeding. I.v. sedation combined with ultrasound-guided, left side TAP blockade can be used successfully as the primary anesthetic modality for PEG placement.

Short-term outcome after cystectomy: comparison of early oral feeding in an enhanced recovery protocol and feeding using Bengmark nasojejunal tube

PurposeCystectomy for bladder cancer is associated with a high risk of postoperative complications. Standardized perioperative protocols, such as enhanced recovery after surgery (ERAS) protocols, aim to improve postoperative outcome. Postoperative feeding strategies are an important part of these protocols. In this two-centre study, we compared complications and length of hospital stay (LOS) between an ERAS protocol with early oral nutrition and a protocol with early enteral feeding with a Bengmark nasojejunal tube.MethodsWe retrospectively reviewed 154 consecutive patients who underwent cystectomy for bladder cancer in two hospitals (Hospital A and B) between 2014 and 2016. Hospital A uses an ERAS protocol (n = 45), which encourages early introduction of an oral diet. Hospital B uses a fast-track protocol comprising feeding with a Bengmark nasojejunal tube (Bengmark-protocol, n = 109). LOS and complications according to Clavien classification were compared between protocols.ResultsOverall 30-day complication rates in the ERAS and Bengmark protocol were similar (64.4 and 67.0%, respectively; p = 0.463). The rate of postoperative ileus (POI) was significantly lower in the Bengmark protocol (11.9% vs. 34.4% in the ERAS protocol, p = 0.009). This association remained significant after adjustment for other variables (odds ratio 0.32, 95% confidence interval 0.11–0.96; p = 0.042). Median LOS did not differ significantly between protocols (10 days vs. 11 days in the ERAS and Bengmark protocols, respectively; p = 0.861).ConclusionsEarly oral nutrition in Hospital A was well tolerated. However, the Bengmark protocol was superior with respect to occurrence of POI. A prospective study may clarify whether the lower rate of POI was due to the use of early nasojejunal tube feeding or other reasons.

Tube feeding during treatment for head and neck cancer – Adherence and patient reported barriers

ObjectivesThe main aim was to investigate the incidence of patient adherence to nutritional tube feeding recommendations in patients with head and neck cancer and to determine patient barriers to meeting tube feeding prescription. Materials and methodsThis was an observational study from a randomised controlled trial in patients with head and neck cancer deemed at high nutritional risk with prophylactic gastrostomy (n=125). Patients were randomised to receive early tube feeding prior to treatment (intervention group) or standard care. All patients in the intervention and standard care groups then commenced clinical tube feeding as required during treatment. Patients maintained a daily record of gastrostomy intake, main nutrition impact symptom necessitating gastrostomy use, and reasons for not meeting nutrition prescription. Adherence was defined as meeting ≥75% of total prescribed intake. ResultsPatients were predominantly male (89%), median age 60, with oropharyngeal tumours (78%), stage IV disease (87%) treated with chemoradiotherapy (87%). Primary reasons for gastrostomy use were poor appetite/dysgeusia (week 2–3) and odynophagia/mucositis (week 4–7). Early tube feeding adherence was 51%. Clinical tube feeding adherence was significantly higher in the intervention group (58% vs 38%, p=0.037). Key barriers to both phases of tube feeding were; nausea, early satiety and treatment factors (related to hospital healthcare processes). ConclusionsEarly tube feeding can improve patient adherence to clinically indicated tube feeding during treatment. Low adherence overall is a likely explanation for clinically significant weight loss despite intensive nutrition interventions. Optimising symptom management and strategies to overcome other barriers are key to improving adherence.Clinical trial registration: This trial has been registered in the Australian New Zealand Clinical Trials registry as ACTRN12612000579897.

Diverging lesion and connectivity patterns influence early and late swallowing recovery after hemispheric stroke.

Knowledge about the recovery of oral intake after hemispheric stroke is important to guide therapeutic decisions, including the administration of enteral tube feeding and the choice of the appropriate feeding route. They aimed to determine the localization and connectivity of lesions in impaired recovery versus recovered swallowing after initially dysphagic stroke. Sixty-two acute ischemic hemispheric stroke patients with impaired oral intake were included in a prospective observational cohort study. Voxel-based lesion-symptom mapping and probabilistic tractography were used to determine the association of lesion location and connectivity with impaired recovery of oral intake ≥7 days (indication for early tube feeding) and ≥4 weeks (indication for percutaneous endoscopic gastrostomy feeding) after stroke. Two distinct patterns influencing recovery of swallowing were recognized. Firstly, impaired recovery of oral intake after ≥7 days was significantly associated with lesions of the superior corona radiata (65% of statistical map, P < 0.05). The affected fibers were connected with the thalamus, primary motor, and supplemental motor areas and the basal ganglia. Secondly, impaired recovery of oral intake after ≥4 weeks significantly correlated with lesions of the anterior insula (54% of statistical map, P < 0.05), which was connected to adjacent operculo-insular areas of deglutition. These findings indicate that early swallowing recovery is influenced by white matter lesions disrupting thalamic and corticobulbar projection fibers. Late recovery is determined by specific cortical lesions affecting association fibers. This knowledge may help clinicians to identify patients at risk of prolonged swallowing problems that would benefit from enteral tube feeding. Hum Brain Mapp 38:2165-2176, 2017. © 2017 Wiley Periodicals, Inc.

Growth and nutrition in children with ataxia telangiectasia

BackgroundAtaxia telangiectasia (A-T) is a rare multisystem disease with high early mortality from lung disease and cancer. Nutritional failure adversely impacts outcomes in many respiratory diseases. Several factors influence nutrition...

Improving the Outcome of Acute Pancreatitis

Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017.

Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: A randomized clinical trial

Background/objectivesThere is substantial evidence of superiority of enteral nutrition (EN) to parenteral nutrition in acute pancreatitis (AP) treatment, but few studies evaluated its effectiveness compared to no intervention. The objective of our trial was to compare the effects of EN to a nil-by-mouth (NBM) regimen in patients with AP. MethodsPatients with AP were randomized to receive either EN via a nasojejunal tube initiated within 24 h of admission or no nutritional support. Systemic inflammatory response syndrome (SIRS) was assessed as the primary outcome. Secondary outcomes included mortality, organ failure, local complications, infected pancreatic necrosis, surgical interventions, length of hospital stay, adverse events and inflammatory response intensity. Outcomes were compared using Student's t-test and Mann–Whitney U test as appropriate. Results214 patients were randomized in total, 107 to each group. SIRS occurrence was similar between groups, with 48 (45%) versus 51 (48%), respectively (RR 0.94; 95% CI 0.71–1.26). No significant reduction of persistent organ failure (RR 0.81; 95% CI 0.52–1.27) and mortality (RR 0.59; 95% CI 0.28–1.23) was present in the EN group. There were no significant differences in other outcomes between the groups. When analyzing the occurrence of SIRS and mortality in subgroup of patients with severe disease no significant differences were noted. ConclusionOur results showed no significant reduction of persistent organ failure and mortality in patients with AP receiving early EN compared to patients treated with no nutritional support (NCT01965873).

Early nasogastric tube feeding in optimising treatment for hyperemesis gravidarum: the MOTHER randomised controlled trial (Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding).

BackgroundHyperemesis gravidarum (HG), or intractable vomiting during pregnancy, is the single most frequent cause of hospital admission in early pregnancy. HG has a major impact on maternal quality of life and has repeatedly been associated with poor pregnancy outcome such as low birth weight. Currently, women with HG are admitted to hospital for intravenous fluid replacement, without receiving specific nutritional attention. Nasogastric tube feeding is sometimes used as last resort treatment. At present no randomised trials on dietary or rehydration interventions have been performed. Small observational studies indicate that enteral tube feeding may have the ability to effectively treat dehydration and malnutrition and alleviate nausea and vomiting symptoms. We aim to evaluate the effectiveness of early enteral tube feeding in addition to standard care on nausea and vomiting symptoms and pregnancy outcomes in HG patients.Methods/DesignThe MOTHER trial is a multicentre open label randomised controlled trial (www.studies-obsgyn.nl/mother). Women ≥ 18 years hospitalised for HG between 5 + 0 and 19 + 6 weeks gestation are eligible for participation. After informed consent participants are randomly allocated to standard care with intravenous rehydration or early enteral tube feeding in addition to standard care. All women keep a weekly diary to record symptoms and dietary intake until 20 weeks gestation. The primary outcome will be neonatal birth weight. Secondary outcomes will be the 24-h Pregnancy Unique Quantification of Emesis and nausea score (PUQE-24), maternal weight gain, dietary intake, duration of hospital stay, number of readmissions, quality of life and side-effects. Also gestational age at birth, placental weight, umbilical cord plasma lipid concentration and neonatal morbidity will be evaluated. Analysis will be according to the intention to treat principle.DiscussionWith this trial we aim to clarify whether early enteral tube feeding is more effective in treating HG than intravenous rehydration alone and improves pregnancy outcome.Trial registrationTrial registration number: NTR4197. Date of registration: October 2nd 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0815-1) contains supplementary material, which is available to authorized users.