Enteral Nutrients Research Articles

Relationship between albumin supply and prognosis in mechanically ventilated patients: a retrospective analysis

To investigate the relationship between enteral nutrient albumin supply and prognosis in patients with mechanical ventilation. The clinical data of 418 mechanically ventilated patients receiving enteral nutrition support treatment in intensive care unit (ICU) of the First Hospital of Jiaxing from January 2016 to June 2019 were retrospectively analyzed. According to whether the daily albumin supply was up to standard, the patients were divided into the standard group (albumin supply was ≥ 1.2 g×kg-1×d-1) and the non-standard group (albumin supply was < 1.2 g×kg-1×d-1). Prealbumin, transferrin levels before and after treatment, 28-day mortality, mechanical ventilation time and the length of ICU stay were compared between the two groups. A total of 418 patients were included, including 225 in the standard group and 193 in the non-standard group. There were no significant differences in gender, age and disease composition between the two groups, and the baseline data were comparable. There was no significant difference in daily calories between the standard group and the non-standard group (kJ/d: 119.73±31.55 vs. 110.05±28.98, P > 0.05), but the daily albumin supply of the standard group was significantly higher than that of the non-qualified group (g×kg-1×d-1: 1.38±0.83 vs. 0.95±0.75, P < 0.05). There was no significant difference in the levels of prealbumin, transferrin between the two groups before treatment. The levels of prealbumin, transferrin in standard group and non-standard group were significantly higher after treatment than before [prealbumin (mg/L): 188.53±69.25 vs. 119.44±57.62, 145.18±56.92 vs. 108.81±69.50; transferrin (g/L): 2.99±0.87 vs. 1.85±0.76, 2.09±0.81 vs. 1.52±0.76, all P < 0.05]. Moreover, prealbumin and transferring in the standard group were further improved than the non-standard group [prealbumin (mg/L): 188.53±69.25 vs. 145.18±56.92, transferrin (g/L): 2.99±0.87 vs. 2.09±0.81, both P < 0.05]. In addition, mechanical ventilation time, the length of ICU stay of the standard group were significantly shorter than those of the non-standard group (hours: 147.2±7.5 vs. 216.6±8.2, 198.8±9.5 vs. 295.4±8.9, both P < 0.05), but there was no statistically significant difference in 28-day mortality [11.56% (26/225) vs. 15.03% (29/193), P > 0.05]. Under the condition of standard enteral nutritional calories, increased of the albumin supply can improve the clinical nutritional status of patients with mechanical ventilation, shorten mechanical ventilation time and hospital stay.

THE POSSIBILITIES OF USING THE DOMESTIC MIXTURE FOR ENTERAL NUTRITION IN THE CORRECTION OF THE UNDERNUTRITION IN CYSTIC FIBROSIS CHILDREN

The article presents the results of clinical observation of cystic fibrosis (CF) patients received the enteral nutrition product Nutrient Standard (Russia) as nutritional support. The high efficiency of this product has been shown for the correction of malnutrition in СF children.

Endoscopic Insertion of Nasojejunal Feeding Tube at Bedside for Critically Ill Patients: Relationship between Tube Position and Intragastric Countercurrent of Contrast Medium

Background and Oblectives: We evaluated the success rate of endoscopically positioned nasojejunal feeding tubes and the intragastric countercurrent of contrast medium thereafter. Method: This retrospective observational study investigated patients who were admitted to a single intensive care unit and required endoscopic placement of a post-pyloric feeding tube between January 2010 and June 2016. The feeding tube was grasped with forceps via a transoral endoscope and inserted into the duodenum or jejunum. Thereafter, we assessed the position of the tube and the intragastric countercurrent using abdominal radiography with contrast medium. Results: The tube tip was inserted at the jejunum and the duodenal fourth portion in 55.8 and 33.6% of patients, respectively. The tip of the inserted tube had moved into the jejunum of 71.7% of patients by the following day. The countercurrent rate was significantly lower among patients with a tube inserted into the duodenal fourth portion or more distal than among those with tubes inserted more proximally (8.4 vs. 45.4%, p = 0.0022). Conclusions: The endoscopic insertion and positioning of a nasojejunal feeding tube seemed effective because the rate of tube insertion into the duodenal fourth portion or more distal was about 90%. The findings of intragastric countercurrents indicated that feeding tubes should be inserted into the duodenal fourth portion or beyond to prevent vomiting and the aspiration of enteral nutrients.

Potential of Local Food-based Enteral Nutrition to Improve Patient’s Nutrition Status in Hospital in Yogyakarta, Indonesia

Most of hospitals in Indonesia provide enteral nutrition from fresh foods, yet it has some weaknesses notably not durable, unstandardized nutrition content, and not ready to use. Improvement of enteral nutrition using local food that containing functional substance is very potential. We aim to formulate local food-based enteral nutrition containing high protein, antioxidant and nutritious; analyze the nutrition contain and conduct organoleptic test of the product. This was pure-experimental study conducted along 2017. There were five steps consisted of: (1) Potential local food selection, such as arrowroot as energy source, fish cork and local tempeh as protein, carrot, green bean sprouts and pumpkin as fiber, vitamin and mineral; (2) Ingredients preparation and early formulation, each ingredient was steamed before flouring to minimize odour of the component. We powdered each component using dryer machine, mashed using blender and filtered using pharmaceutical sieve; (3) Nutrition analyses, energy and protein per 100 grams ingredients were 352.69 kcal and 0.23 grams (starch arrowroot), 355 kcal and 0.73 grams (arrowroot flour), 392.17 kcal and 79.33 grams (fish cork flour), 449.67 kcal and 46.5 grams (local tempeh flour), 354 kcal and 38.5 grams (mung bean sprout flour), 356.33 kcal and 10 grams (carrot flour) and 380.63 kcal and 12.67 grams (yellow pumpkin flour); (4) Organoleptic test, conducted by trained panelists. Due to low acceptability and bad flavour impact on the product, arrowroot flour, carrot and mung bean sprouts flour were removed from the formula of the product; (5) Formulation, all components were mixed using homogenous mixer machine and were added skim milk, full cream milk, palm sugar, rice flour and essence into the product to improve nutrition contains and organoleptic components. The conclusion is that starch arrowroot, fish cork, local tempeh and yellow pumpkin floured are potential to be formulated as enteral food to improve nutritional status among malnutrition patients.

Therapeutic Effects of Endogenous Incretin Hormones and Exogenous Incretin-Based Medications in Sepsis.

Sepsis, a complex disorder characterized by a dysregulated immune response to an inciting infection, affects over one million Americans annually. Dysglycemia during sepsis hospitalization confers increased risk of organ dysfunction and death, and novel targets for the treatment of sepsis and maintenance of glucose homeostasis are needed. Incretin hormones are secreted by enteroendocrine cells in response to enteral nutrients and potentiate insulin release from pancreatic β cells in a glucose-dependent manner, thereby reducing the risk of insulin-induced hypoglycemia. Incretin hormones also reduce systemic inflammation in preclinical studies, but studies of incretins in the setting of sepsis are limited. In this bench-to-bedside mini-review, we detail the evidence to support incretin hormones as a therapeutic target in patients with sepsis. We performed a PubMed search using the medical subject headings "incretins," "glucagon-like peptide-1," "gastric inhibitory peptide," "inflammation," and "sepsis." Incretin-based therapies decrease immune cell activation, inhibit proinflammatory cytokine release, and reduce organ dysfunction and mortality in preclinical models of sepsis. Several small clinical trials in critically ill patients have suggested potential benefit in glycemic control using exogenous incretin infusions, but these studies had limited power and were performed in mixed populations. Further clinical studies examining incretins specifically in septic populations are needed. Targeting the incretin hormone axis in sepsis may provide a means of not only promoting euglycemia in sepsis but also attenuating the proinflammatory response and improving clinical outcomes.

Formulation and processing of gruels made from local ingredients, thin enough to flow by gravity in enteral tube feeding

Designing enteral foods from local ingredients for tube feeding of low-income people who cannot eat orally is needed. Two processing methods, involving the addition of amylase or malt, were used to thin a blenderized tube feeding formula based on sorghum, sesame and soybean seeds. Two composite flours, either with higher carbohydrate (F1D) or higher lipid (F2D) contents were formulated to obtain an enteral food aimed at adults. To thin the formula enough for it to flow inside the feeding tube, increasing concentrations of amylase (0.27-2.17g/100g DM) were added to gruels F1D (F1DE) and F2D (F2DE) prepared at 25% DM. Sorghum malt was also added to F1D (F1DM) as an alternative source of amylase. But F1DE and F1DM flow times in a 50cm feeding tube (10 Fr) remained much longer (up to 14s) than that of the commercial enteral food (4s). The F1DE and F1DM osmolalities (485 and 599 mOsmol/Kg water, respectively) were higher compared to that of F1D but remained within the range specified for adult enteral food. F1D, F1DE and F1DM gruels showed pseudoplastic behavior. Their loss ratio (tan ), elastic (G') and loss (G'') moduli were similar, but apparent viscosity, flow time in the feeding tube and consistency index (k) showed that F1DE was thinner than F1DM. Adding an incubation step before cooking of F1DM suspension allowed further thinning of the gruel, showing it is possible to formulate an enteral food using local ingredients that flows by gravity in the feeding tube.

Manufacturing Process, In Vivo and In Vitro Digestibility Assessment of an Enteral Feeding Product Hydrolyzed from Locally Available Ingredients Using Commercial Enzymes

A ready-for-use enteral feeding product was manufactured based on energy standard mixing using hydrolyzed products from local foods (i.e., loin pork, carrot, pumpkin, soybean, rice, and potato). When compared to enteral foods based on defined ingredients, the manufactured product is more cost-effective, appropriately functional and has similar physicochemical properties. Relative protein digestibility for in vitro value was tested by using enzyme pepsin, pH-drop and pH-stat method with three different enzymes. The product was shown to be easily digested with an in vivo digestibility value of 89.7%. Molecule sizes of components in the product ranged from 3.5 to 8.5 kDa, determined by SDS-PAGE, and the average molecular weight was 1.52 kDa, determined by Gel Permeation Chromatography (GPC) method. In terms of nutritional value, the product achieved a caloric density of 1 kcal/mL, dietary fibers of 1.48 g per 100 mL and provided both oligomeric and monomeric forms of protein. In addition, the product has the leucine: isoleucine: valine ratio of 2:1:1, thus facilitating the absorption of the protein. In conclusion, the manufactured enteral feeding product has been shown to be appropriate for providing nutritional support for patients.

Radiation processing of locust bean gum and assessing its functionality for applications in probiotic and enteral foods

The physicochemical and functional characteristics of irradiated locust bean gum (LBG) were investigated for their use as a source of dietary fibre in enteral food. Radiation processing mainly affected the molecular weight of the polymer in dose-dependent manner. The attributes like lowering of viscosity, increase in solubility and swelling index were better achieved with the use of irradiated polymer. A 17% reduction in glucose dialysis retardation index (GDRI) and decrease in bile acid dialysis retardation index (BDRI) due to irradiation were in agreement with the rate of depolymerization. LBG was also shown to protect probiotic L. plantarum cells during their passage in gastrointestinal conditions. Radiation processing of the gum further improved this property exhibiting only 3 log cycle decrease in count as compared to unirradiated polymer, exhibiting nearly 4 log cycle decrease from initial cell count of 9 log CFU mL−1. In view of the changes in the rheological properties of LBG due to irradiation, an enteral feed supplemented with irradiated LBG as source of dietary fiber was prepared without affecting the product viscosity.

Rationale for and Design of the Study of Early Enteral Dextrose in Sepsis: A Pilot Placebo‐Controlled Randomized Clinical Trial

Sepsis is characterized by life-threatening organ dysfunction caused by a dysregulated host response to infection and affects over 1 million Americans annually. Loss of glycemic control in sepsis is associated with increased morbidity and mortality, and novel approaches are needed to promote euglycemia and improve outcomes in sepsis. Recent studies from our laboratory demonstrate that early low-level enteral dextrose infusion in septic mice attenuates the systemic inflammatory response and improves glycemic control by inducing intestine-derived incretin hormone secretion. The aim of the Study of Early Enteral Dextrose in Sepsis (SEEDS) is to test the effect of a 24-hour enteral dextrose infusion in critically ill septic patients as a therapeutic agent to decrease systemic inflammation and promote euglycemia. SEEDS is a single-center, double-blind, randomized, controlled trial that will enroll 60 septic patients admitted to the intensive care units at the University of Pittsburgh Medical Center Health System in Pittsburgh. Participants will be randomized 1:1 to receive enteral dextrose (n=30) or water (placebo, n=30) infusion for 24 hours. The primary outcome is the circulating interleukin-6 level measured after the 24-hour infusion compared between dextrose and placebo groups. Secondary outcomes include postinfusion circulating insulin, incretin, and other proinflammatory cytokine levels, as well as incidence of hyperglycemia and hypoglycemia during the infusion period. This trial will characterize the effects of early enteral dextrose on endogenous endocrine pathways and the systemic inflammatory response in sepsis. The results of this trial will inform future larger interventional studies of early enteral nutrients in critically ill patients with sepsis.

Effects of food type on the extent of drug-drug interactions between activated charcoal and phenobarbital in rats

Activated charcoal is known to decrease the intestinal absorption of co-administered drug by adsorption. The extent of this drug-drug interaction (DDI) is attenuated by food intake. The aim of this study was to quantitatively evaluate the effects of food type on the extent of DDI between phenobarbital and activated charcoal using a rat model. Phenobarbital was orally administered at a dose of 1.5 mg/kg with or without 33 mg/kg of activated charcoal under fasted or fed conditions, and the plasma concentration profile of phenobarbital was monitored. Several fed conditions, such as a standard breakfast, high-fat meal or enteral nutrient used in human studies, were examined. Under the fasted conditions, activated charcoal significantly decreased the area under the plasma concentration - time curve (AUC) of phenobarbital by 45.2%. When the standard breakfast or high-fat meal was fed, this DDI was reduced to 28.3 and 18.0%, respectively, as assessed by the reduction in the AUC. On the contrary, enteral nutrient did not significantly attenuate the DDI. In conclusion, the influence of food intake on the extent of DDI between phenobarbital and activated charcoal was found to differ among the types of food concomitantly ingested.

OLIGOSACCHARIDES IN HUMAN MILK AND IN MILK FORMULAS FOR PRETERM INFANTS – VALUE FOR PRETERM INFANTS

Better long-term survival of very preterm infants depends on optimizing the methods of their nutritional support. Today it is widely recognized that mother’s breast milk is the optimal enteral food for this extremely vulnerable infant population, becausebreast milk feeding reduces their morbidity and mortality. The advantages of breast milkfeeding are related to the biologically active components of breast milk, especially oligosaccharides (OS),concentration of which is only less than amount of lactose and fat. Available experimental and clinical data suggest that the positive clinical effect of the OS can be mostly structure-specific, since the spectrum of human milk oligosaccharides (HMO) is quite wide and includes more than 200 known different compounds. The content of the OS in breast milk is individual and depends on many factors. Despite the emergence of the potential for industrial synthesis of several HMOs, there are currently no results of interventional clinical studies with the use of food products for preterm infants enriched with such OS. Instead, the available data prove positive clinical effects of enrichment of formulas and breast milkwith synthetic OS, which, by their biological properties, mimicHMO. The largest number of such scientific data exists with respect to a special complex of OS, consisting of short-chain galactooligosaccharides (scGOS) and long-chain fructooligosaccharides (lcFOS) in a ratio of 9:1 with the possible addition of galacturonic acid. The article presentscurrent data on functional biology of HMO, clinical effectiveness of the use of synthetic OS in preterm infants, as well as future challenges and opportunities associated with the clinical application of the OS.

Clinical efficacy of early combined nutrition in neurosurgical intensive patients.

Objective To explore the clinical efficacy of early combined application of parenteral nutrition and enteral nutrition among patients in neurosurgical intensive care unit(NICU). Methods Two hundred fifty-five patients with severe neurological diseases were admitted to NICU of Shanghai Tenth People's Hospital from January 1 to August 31 in 2018. The patients were divided into two groups: traditional enteral nutrition group (control group, n=170), who were treated with enteral nutrition management at the early stage, and early combined application of parenteral and enteral nutrition group (experimental group, n=85), who were at first treated with parenteral nutrition since admission and then enteral nutrition management 72 hours later. The differences of Glasgow outcome scale (GOS), incidence of individual adverse reactions, daily average enteral nutrition, human albumin supplement, daily average fluid supplement, pulmonary infection rate, infection time and albumin level during hospitalization between the two groups were compared. The relationship among the course of enteral nutrition, nutrient content, pulmonary infection and serum albumin level in the experimental group were also discussed. The GOS was predicted by decision tree, random forests, nearest neighbor algorithm, adaboost and bagging. Results There was no significant difference between baseline scores after 1:2 propensity score matching. The dominance ratio of GOS between the two groups was 1.853 (95%CI: 1.018-3.385) (P=0.043). The change of albumin level was not related to the choice of nutritional regimen, but was related to the level of consciousness after admission and the level of basic albumin before admission. The level of consciousness in the experimental group was higher than that of the control group, and the fluid infusion volume was decreased while the daily average enteral nutrition and albumin supplementation were increased, the types of adverse reactions occurred more and earlier (P<0.05). The misjudgment rate of GOS prediction models ranged from 0.482 to 0.606. Conclusions Compared with traditional early enteral nutrition therapy, early combined parenteral nutrition and enteral nutition can improve the prognosis of patients with severe neurological diseases. Key words: Neurosurgical intensive patients; Early combined application; Enteral nutrition; Glasgow outcome scale

Effects of semi-solidification of enteral nutrients on the pharmacokinetic behavior of orally administered carbamazepine in rats.

The use of semi-solid enteral nutrients plays an extremely important role in accurate nutrition management. In the present study, we compared the pharmacokinetic profile of orally administered carbamazepine (CBZ) in rats treated with liquid RACOL®, semi-solid RACOL®, and HINE E-gel®, which are enteral nutrients marketed in Japan. Since liquid and semi-solid formulations are both marketed in Japan for RACOL®, liquid RACOL® was orally administered to control rats. The serum concentration of CBZ at each sampling point was lower in the semi-solid RACOL®-treated group than in the liquid RACOL®-treated group. No significant differences were observed in the pharmacokinetic behavior of CBZ between the semi-solid RACOL®-treated and HINE E-gel®-treated groups. Regarding pharmacokinetic parameters, the impact of the area under the curve (AUC0→5h) was the liquid RACOL® group > the semi-solid RACOL® group ≈ the HINE E-gel® group. Therefore, we concluded that serum concentrations of CBZ were lower when concurrently treating with semi-solid enteral nutrients than when simultaneously processing liquid enteral nutrients.

Evaluation of Taste of Enteral Nutrient Ice Cream and Search for Factors Affecting the Taste

Objectives: Patients' adherence to enteral administration of nutrients is influenced by their feeling during administration. The present study compared the taste of commercially prepared ice cream with that of enteral nutrient ice cream, using a sensory test. Additionally, the factors influencing the comprehensive evaluation of enteral nutrient ice cream and commercially prepared ice cream were identified. Methods: A sensory test was performed by 30 pharmacists, on commercially prepared ice cream and enteral nutrient ice cream using the Semantic Differential Method. The factors related to comprehensive evaluation were extracted, and those influencing the comprehensive evaluation of ice cream were analyzed by Covariance structure analysis. Results: No significant differences were observed in the comprehensive evaluation of enteral nutrient ice cream and commercially prepared ice cream (p = 0.08, 95% CI = −0.78 to 0.04). Covariance structure analysis identified five factors related to Easy-to-intake (i.e., Taste, Ease to ingest, Continuity, Peculiar flavor, and Familiarity), which strongly influenced Comprehensive evaluation (standardized estimated value: 0.88). In addition, four factors related to discomfort factor (i.e., Feeling of heaviness, Concentration of taste, Greasiness, and Milky smell) were found not to influence Comprehensive evaluation directly but were correlated with Ease-to-intake (standardized estimate: 0.64). Conclusion: It is important for healthcare professionals to understand the factors involved in the comprehensive evaluation of enteral nutrients, and they should provide appropriate information about it.

Application of nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases

Objective To investigate the efficacy and safety of nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases. Methods A retrospective analysis of 30 children with serious illness who were given enteral nutrient solution through the nasogastric feeding tube placed by endoscopy from January 2013 to May 2016 in our hospital was conducted including 12 boys and 18 girls aging from 2 months to 14 years with the mean as (6.86±3.44) years old. Catheterization condition including catheter insertion time after hospitalization, catheter maintenance time, hospital stay and retention time after discharge, postoperative complications after catheterization, prognostic indications including anal exhaust and defecation time, blood urine amylase and returning to normal time, and changes of the indicators for nutrition including total protein, albumin, prealbumin, retinol binding protein were analyzed. Results Catheter insertion time after hospitalization was (16.13±10.51) days, catheter maintenance time (21.35±9.62) days, hospitalization time after catheterization (20.10±8.96) days and hospital stay (36.23±14.20) days. 10 cases (33.3%) maintained the catheter for (11.10±4.65) days after the discharge. The anal exhaust time was (2.84±3.32) days and the defecation time (4.55±3.35) days; The urinary amylase significantly deceased three days after catheterization compared with that of one day before catheterization (P=0.047); Serum total protein, albumin, prealbumin and retinol binding protein increased three days after catheterization compared with that of one day before catheterization, but the difference was not statistically significant (P>0.05). 5 children (17%) had complications including 3 children of abdominal distension and 2 children of vomiting. Conclusions Nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases can improve the intestinal and pancreatic function, recover their nutritional status to some extent and be controlled safely. However, the waiting time for catheterization and the hospital stay after catheterization are relatively long. The implementation of this technology and the awareness of its safety need be strengthened. Key words: Endoscopy; Nasogastric feeding tube; Enteral nutrition; Children

Effects of oral ingestion on physical functions before tube feeding in adults with severe motor and intellectual disabilities.

This study aimed to determine the significance of oral ingestion in tube-fed adults. Six males and three females (mean age 48.1 ± 12.4years) with severe motor and intellectual disabilities were included in this study. The subjects were monitored for cerebral blood flow (CBF) by functional near-infrared spectroscopy imaging, gastric motor function by electrogastrography, and arterial oxygen saturation (SpO2) and pulse rate with a biological data monitoring device. The subjects were divided into two groups, settings A and B. In setting A, after resting for 30min, the subjects were tube fed a routinely used enteral nutrient solution. In Setting B, the subjects received 10cc of thickened enteral nutrient solution prior to tube feeding. Cerebral function as measured by CBF significantly increased after tube feeding under setting A (without oral ingestion), as compared to the resting state. Under setting B (with oral ingestion), CBF significantly increased after oral ingestion and after tube feeding. SpO2 significantly decreased under setting B after oral ingestion and after tube feeding. Gastric motor function showed no significant change after tube feeding in either setting. The pulse rate significantly increased before tube feeding as compared to that in the resting state, after feeding as compared to before feeding and after feeding as compared to the resting state. Our data suggest that introducing oral ingestion, at least partially, in tube-fed individuals with severe dysphagia is beneficial in that it can stimulate cerebral function.

Alterations in Pharmacokinetics of Orally Administered Carbamazepine in Rats Treated with Sodium alginate: Possible Interaction between Therapeutic Drugs and Semi-solid Enteral Nutrients.

The use of enteral nutrients plays an extremely important role in accurate nutrition management. Sodium alginate (SA) is frequently used for the semi-solidification of enteral nutrients. In the present study, we investigated whether the pharmacokinetic profile of orally administered carbamazepine (CBZ) is altered by a treatment with SA immediately before and after dosing of the drug. Furthermore, the adsorption effects of SA on CBZ were examined using an in vitro analysis. SA was orally administered to rats just before and immediately after CBZ dosing. The CBZ concentration profile following its oral administration was analyzed by a non-compartmental method. The adsorption of CBZ onto SA was evaluated after centrifugation using an ultrafiltration device. The serum concentration of orally administered CBZ at each sampling point was reduced by the treatment with SA, and the extent of the decrease observed in the concentration of CBZ was larger when SA was ingested immediately after administration of the drug, which was consistent with the alteration observed in the value of the area under the curve (AUC). No significant differences were noted in the elimination rate at the terminal phase (ke) among the groups. In the in vitro assay, CBZ was adsorbed by SA in the solution used to reflect fluid in the intestinal tract. The pharmacological efficacies of CBZ might be reduced by SA through the pharmacokinetic interactions, and that the careful attention should be paid to the timing of administration of CBZ and semi-solid enteral nutrients.

Evaluation of the effectiveness of different types of enteral nutrition in premature infants

Introduction. Optimal nutrition of premature baby should ensure him adequate growth without metabolic and other complications in the short term, with the realization of genetic potential and development in the long-term perspective. The most valuable product for such infants is breast milk, which has nutritional, immunological, psychological, social and economic benefits over milk mixtures. However, in all cases, it is not possible to feed a premature infant with suckling breast milk (difficult conditions are menses, the presence of contraindications for breastfeeding). In such circumstances, the physician poses the question of choosing a mixture of enteral nutrition that would provide the body of a premature baby with all the necessary nutrients, allow for adequate growth rates of increase in feeding volume and minimize the development of complications.The aim of the study. To analyze the outcomes of children with very low body weight at birth, depending on the nature of the enteral nutrition.Materials and methods. Clinical and laboratory examination of 68 premature infants with very low body weight at birth (1000 g-1500 g) was conducted. Of the 24 children (Group I), enteral nutrition was carried out from the first hours of life with breast milk, in the 44 (second group) newborns - early enteral nutrition with a mixture of PreNAN Gold. Exclusion criteria: congenital malformations and abnormalities requiring surgical intervention, conditions delaying the early onset of enteral nutrition.A daily clinical assessment of the general condition of newborns, neurological status, weighing, monitoring of growth parameters, head circumference and abdomen were carried out. All children were thoroughly examined before each feeding for the purpose of identifying symptoms of tolerance to enteral nutrition, monitoring the results of laboratory and additional research methods in accordance with the protocols for the provision of newborns approved by the orders of the Ministry of Health of Ukraine.Results and discussion. Part of the children of the second group for 4-5 days of life, in addition to the mixture, began to receive and strained breast milk (they are classified in IIa subgroups). The weight loss of newborns who fed with the PreNAN Gold blend was probably lower compared to those in Group I infants. The average increase in the daily volume of enteral nutrition during the first week of life did not differ significantly in all groups of children. The achievement of full volume of enteral nutrition was most rapidly observed in newborn infants receiving breast milk. However, body weight gain was better for babies on artificial feeding. Cases of intolerance to enteral nutrition were almost the same in all infant groups, but the incidence of necrotizing enterocolitis did not differ with all types of enteral nutrition. In newborns who received PreNAN Gold, the stomach did not contain pathological impurities. Data from laboratory studies in Group II (total protein, urea, creatinine) were within the age range. Allergic reactions were not registered.Conclusions. The use of the PreNAN Gold blend for the feeding of prematurely born infants with a very low body weight at birth allows them to fully provide their body with all necessary nutrients, allow them to maintain proper rates of increase in feeding volume, promote adequate body weight gain, minimize the development of NEC and disturb the tolerance to enteral food. The mixture is well tolerated by infants, does not cause allergic reactions, the liquid form simplifies its use.

Nutrition Practices and Predictors of Postnatal Growth in Preterm Infants During Hospitalization

The aim of the study was to evaluate the relation between nutrition practices and growth rate in preterm infants from birth to 36 weeks postmenstrual age (PMA). Longitudinal data were collected retrospectively in 103 infants born <33 weeks gestation admitted to Dunedin Neonatal Intensive Care Unit, New Zealand. Weight, length, and head circumference at birth and 36 weeks PMA z scores were calculated using the INTERGROWTH Preterm Growth Standard. Growth velocity (g · kg · day) was determined via exponential model. Time to regain birth weight and nutritional practices including enteral nutrition, withholding feeds, nutrient intake, and feeding at discharge were described. Regression was used to explore associations between growth and nutritional variables. Growth faltering (weight-for-age z score <-1.28/10th centile) increased from 9% at birth to 19% at 36 weeks PMA. Mean (standard deviation) growth velocity in-hospital (14.2 [3.3] g · kg · day) was well below the desirable rate of 18 g · kg · day. Forty-one percent of infants had feeds withheld, which was significantly associated with a longer time period to achieve full enteral feedings (P < 0.001) and poorer weight and length z score at 36 weeks PMA (both P < 0.05). The day of life to establish full enteral feedings was longer than recommended yet positively associated with weight at 36 weeks PMA (P = 0.019), whereas controlling for withholding feeds and other known confounders. Extrauterine growth restriction was highly prevalent in this population. The negative association of withholding of feeds on growth reinforces the need to evaluate early life feeding protocols and further assess the longer-term influence of this practice on postdischarge growth outcomes.

Enteral Nutrients and Gastrointestinal Physiology.

The gastrointestinal (GI) tract is a highly efficient organ system with specialized structures to facilitate digestion and absorption of nutrients to meet the body's needs. The presence of nutrients in the GI tract supports optimal structure and function, stimulates regulatory hormones, and supports the microbiota, the population of microorganisms residing in the GI tract. A lack of enteral nutrition (EN) results in impaired GI integrity and serious patient complications, making EN a priority. Normal GI physiology is reviewed, and the regulatory impact of luminal nutrients on GI function is discussed.