Feeding Intolerance Research Articles

Repetitive Feeding-Challenge With Different Nutritional Densities on Markers of Gastrointestinal Function, Substrate Oxidation, and Endurance Exercise Performance.

Gut-training has been shown to improve gastrointestinal tolerance, circulatory glucose availability, and exercise performance. The study aimed to investigate the effects of a repetitive feeding-challenge using fat versus carbohydrate (CHO) on markers of gastrointestinal function, glucose availability, and subsequent performance when challenged with a high-CHO load (87g/hr) during exercise. Forty-four endurance athletes (mean ± SD [9 females and 35 males]: body mass: 71.2 ± 9.2kg, height: 173.6 ± 7.0cm, V˙O2max: 55.0 ± 6.1ml·kg-1·min-1) completed a preintervention gut-challenge trial (T1), involving a 2hr run (60% V˙O2max) while taking a CHO gel every 20min (87g/hr, 10% w/v), followed by a 1hr self-paced distance test with ad libitum water. Participants were then randomized to a fat (fat feeding-challenge [FFC]; 20g nut butter, 124kcal, 11g fat, 3g protein, and 3g CHO) or CHO supplement (CHO feeding-challenge [CFC]; 47g CHO gel: 123kcal, 29g CHO) group to complete a 7-day repetitive feeding-challenge (1hr exercise and supplement intake every 20min with 290ml water), followed by a gut-challenge retrial (T2). FFC did not differ from CFC in terms of resting orocecal transit time, feeding tolerance, or substrate oxidation during T1 and T2. Peak breath hydrogen was lower in FFC than CFC (p = .028) at T2. Total (FFC: 27%, p = .005 vs. CFC: 38%, p = .001) and upper gastrointestinal symptoms severity (FFC: 26%, p = .013 vs. CFC: 40%, p < .001) during exercise was reduced similarly between groups from T1 to T2. FFC covered more distance in T2 (11.51 ± 2.02 vs. 11.08 ± 2.02km, p = .013), but not significantly different to CFC (p = .341). A repetitive feeding-challenge with fat does not enhance nor worsen gastrointestinal and fueling outcomes compared with a CHO repetitive feeding-challenge.

Nutrition Provision in Pediatric Extracorporeal Membrane Oxygenation: Evidence, Challenges, and Clinical Considerations

Background/Objectives: Nutritional support is a critical yet challenging aspect of care for pediatric patients requiring extracorporeal membrane oxygenation (ECMO). Malnutrition is prevalent in this population and is associated with worse clinical outcomes. This review synthesizes current evidence on nutritional strategies for pediatric ECMO patients, emphasizing assessment methods, feeding routes, challenges, and clinical outcomes. Methods: A literature review was conducted using PubMed, Scopus, and Web of Science to identify relevant studies published between January 2010 and 2025. Keywords included “pediatric ECMO”, “nutrition”, “enteral feeding”, and “parenteral nutrition”. Studies addressing nutritional assessment, enteral and parenteral feeding practices, and their impact on clinical outcomes were included. Results: Malnutrition is a significant risk factor for morbidity and mortality in ECMO patients, yet nutritional support remains highly variable. While enteral nutrition (EN) is preferred, feeding intolerance and gastrointestinal dysfunction often necessitate parenteral nutrition (PN). Early EN initiation, even at trophic levels, is associated with improved gut integrity and outcomes. However, achieving full nutritional goals enterally remains a challenge, particularly in neonates. PN remains essential in cases of feeding intolerance but is linked to hepatic dysfunction and metabolic imbalances. Conclusions: Optimizing nutritional support in pediatric ECMO patients requires individualized assessment and a structured approach to enteral and parenteral feeding. Further research is needed to establish standardized feeding protocols and determine the optimal timing and composition of nutritional support to improve outcomes.

Investigating key factors of feeding intolerance in sepsis: A scoping review.

At present, domestic and international research on the current status of feeding intolerance in septicemia patients only stops at the study of influencing factors; however, due to the specificity of the disease, the influencing factors are numerous and controversial. To systematically analyse the studies related to the occurrence of feeding intolerance in patients with sepsis, to find out the influencing factors of feeding intolerance in these patients and to provide a reference for nursing staff to develop relevant interventions. The study employed Arksey and O'Malley's methodology to carry out a scoping review. We conducted a systematic search, using the scoping review as a framework, for relevant Chinese and English literature on factors influencing feeding intolerance in patients with sepsis in China Knowledge Network, Wanfang, CINAHL, Pubmed, Web of Science and Google Scholar, covering a time frame from construction to 1 September 2024. We identified research questions, completed literature screening and quality assessment, extracted data and summarized and analysed the data. The review included a total of 13 papers. Factors influencing feeding intolerance in septicemia patients included patient factors, disease factors, biochemical indicators, feeding determinants, clinical treatment and drug effects. Factors affecting feeding intolerance in patients with sepsis are multifaceted. We should develop individualized care plans based on relevant risk factors to improve feeding tolerance and shorten hospital stays in patients with sepsis. In order to improve the ability of ICU nurses to identify the risk factors of feeding intolerance in patients with sepsis, it is recommended to conduct systematic training on the pathophysiology of sepsis, influencing factors of feeding intolerance and intervention measures and assist nurses to implement appropriate intervention measures.

Feeding Tolerance to a Running Gut-Challenge Protocol: a Cross-Sectional Exploration.

This study examined gastrointestinal function, substrate utilization, and exercise performance differences in response to a gut-challenge between (1) female and male athletes, (2) young adult versus masters athletes, and (3) athletes with or without exercise-associated gastrointestinal symptom history (Ex-GIS). Fifty-three endurance athletes (43 males and 10 females) completed a gut-challenge involving a 2-hour run (60% V̇O2max) with 90 g/h carbohydrate intake, followed by a 1-hour self-paced distance test (DT) with ad libitum water. Blood and breath samples were collected pre- and post-exercise. Blood glucose and substrate utilization during exercise were measured, while Ex-GIS and feeding tolerance were assessed pre-, during, and post-exercise. Interest in food and appetite during exercise was lower in symptomatic athletes than asymptomatic athletes (p<0.05). Females had a higher blood glucose concentration during exercise (p=0.037) and immediately after exercise (p=0.003) and a lower whole-body fat oxidation rate during exercise (p=0.009). Exercise performance did not differ based on the biological sex, age, and Ex-GIS history. Overall, gastrointestinal functional markers were comparable between groups, while feeding tolerance and substrate availability and utilization appear to be influenced by the Ex-GIS history and biological sex, respectively. Tailored management of gastrointestinal issues in athletes should be based on an individual basis as opposed to general demographic characteristics.

3-Year-Old Female with Specific Antibody Deficiency and 9p Duplication Treated with Replacement Immunoglobulin

The patient is a 3-year-old female with a history of hypoxic-ischemic encephalopathy, cerebral palsy, global developmental delay, hypotonia, epilepsy, feeding intolerance with known aspirations, and chronic lung disease who presented to immunology for evaluation of recurrent, severe upper and lower respiratory tract infections. In the past year, she reported monthly upper respiratory infections, three of which progressed to pneumonia requiring antibiotic treatment, and two of which required hospitalization for severe respiratory failure. She denied lifetime otitis, sinusitis, cutaneous, or other invasive or serious infections. Immunological evaluation demonstrated normal lymphocyte subsets, B cell phenotyping, naïve/memory T cell phenotyping, immunoglobulins, non-protective tetanus titer, protective diphtheria titer, and protective hepatitis B titer. The patient had 2/23 Streptococcus pneumoniae titers protective above 1.3 mcg/mL after initial Prevnar 13 administration and then only 4/14 S. pneumoniae titers protective above 1.3 mcg/mL after Pneumovax 23 booster. The patient had normal lymphocyte proliferative responses to PHA, PWM, soluble anti-CD3, and anti–CD3+IL-2 though decreased to soluble anti–CD+anti-CD28. Genetic testing detected a heterozygous known pathogenic VARS2 variant (c.1546G&amp;gt;T and p.Glu516*) associated with autosomal recessive combined oxidative phosphorylation deficiency in addition to 9p24.2 duplication. VARS2 encodes a key enzyme for mitochondrial protein synthesis 1. 9p duplication is associated with global developmental delay similar to the patient’s phenotype but has not been specifically linked to abnormalities in the immune system. Despite initial treatment with prophylactic azithromycin and revaccination for S. pneumoniae, the patient developed COVID-19 pneumonia and rhino enterovirus with severe respiratory failure requiring two separate hospitalizations over three months and no significant improvement in strep pneumoniae titers. Subcutaneous immunoglobulin replacement therapy was initiated, and she has been on biweekly subcutaneous immunoglobulin replacement for four months with symptomatic improvement and no further infectious diagnosis. This case highlights that patients with 9p duplication and other rare genetic disorders are at risk for immune dysfunction and can benefit from replacement immunoglobulin. Patients with rare genetic disorders that have not been previously linked to immune dysfunction should be evaluated by an immunologist if recurrent infections.

Unconditioned Hematopoietic Stem Cell Transplant in Hypomorphic RAG1-Associated Severe Combined Immunodeficiency Complicated by Cytomegalovirus Viremia and Inflammatory Bowel Disease

Introduction Managing hypomorphic RAG1-associated severe combined immunodeficiency (SCID) prior to hematopoietic stem cell transplant (HSCT) represents a unique therapeutic challenge as clinicians are charged with preventing and treating opportunistic infections while often simultaneously controlling the consequences of immune dysregulation. We describe a particularly challenging case of treatment-resistant cytomegalovirus (CMV) viremia and significant inflammatory bowel disease in a Mennonite infant with hypomorphic RAG1-associated SCID, ultimately treated with unconditioned HSCT. Case A Mennonite breastfed female with SCID secondary to homozygous RAG1 c.527G&amp;gt;T variants (older brother shared genotype) presented at 10 months old with an acute diarrheal illness, found to have cryptosporidium gastroenteritis and CMV viremia. She had rising CMV viral load despite treatment with ganciclovir, valganciclovir, foscarnet, and cidofovir sequentially, as well as 5 maternally derived CMV-specific cytotoxic T lymphocyte infusions. She had poor weight gain, chronic diarrhea, feed intolerance requiring parenteral nutrition, peri-rectal ulcers, and colonoscopy consistent with IBD. IBD was treated with triple antibiotic therapy alone given significant risk with further immunosuppression. B cell depletion with rituximab was pursued to eliminate potential anti–type I interferon antibody–producing B cells and augment CMV clearance. CMV-directed therapies were ultimately discontinued given continued treatment resistance and adverse side effects. She received an unconditioned haploidentical peripheral stem cell transplant with TCRαβ+/CD19+ cell depletion at 18 months old. Engraftment studies showed 34% donor chimerism in the T cell lineage at 3 months post-HSCT, which gradually increased to 80% at 1 year post-HSCT. At 1 year post-HSCT, immune phenotyping showed modestly increased naive T cells, normalized lymphocyte proliferative response to mitogen stimulation, and predominantly polyclonal TCR Vb repertoire. She remained with minimal B cell and myeloid donor engraftment and is maintained on immunoglobulin replacement therapy. Clinically, her GI disease improved with tolerance of complete enteral feeds since 10 months post-HSCT. At 1 year post-HSCT, her CMV viral load was undetectable. Conclusions We report a remarkably positive and unexpected outcome of rising T cell engraftment, clearance of previously treatment-resistant CMV viremia, and marked improvement in IBD symptoms after unconditioned HSCT for hypomorphic RAG1-associated SCID, adding to the field’s important and ever-growing experience in managing this challenging condition.

Utility of Abdominal Near Infrared Spectroscopy in the Management of Neonates: A Review.

Near-infrared spectroscopy (NIRS) is a noninvasive technique that utilizes light in the near-infrared spectrum to assess regional tissue oxygenation. The initial application of NIRS focused on measuring cerebral oxygenation. Recently, numerous studies focused on the utility of NIRS in measuring abdominal regional perfusion in preterm and full-term neonates-hepatic (right subcostal) and mesenteric (left lower quadrant/infra-umbilical probe). Abdominal NIRS, specifically the infraumbilical values obtained within the first week of life, is a useful tool for the evaluation of feeding intolerance and an early marker of the development of necrotizing enterocolitis (NEC) as changes in NIRS in the first 24 hours of abdominal symptoms helps define NEC severity. In addition, NIRS holds promise in identifying changes in abdominal regional perfusion with blood transfusion. The goal of this review is to summarize the current knowledge of factors affecting abdominal NIRS measurements, specifically alterations associated with feeding, blood transfusion, and necrotizing enterocolitis (NEC). We present information from the published clinical research in conjunction with information collected from an extensive search in the databases PubMed, EMBASE, and Scopus. · Abdominal NIRS is still an underutilized tool at the bedside in various clinical conditions.. · Compared with cerebral NIRS, splanchnic NIRS has more variability.. · Splanchnic NIRS can be used for clinical conditions such as feeding, blood transfusion, and NEC.. · There is a need for standardized algorithms in infants based on their GA and clinical diagnosis..

Improving Milk Donation at a Comprehensive Lactation Management Center and its Implications on Post-natal and Post-operative Ward Neonates – A Quality Improvement Project

Objectives To improve monthly milk donation by 30% from 25.4 L to 33 L over 17 months in a comprehensive lactation management center (CLMC) and to study its implications on postnatal and postoperative ward neonates. Material and Methods This is a quality improvement (QI) project, conducted from Jan 2022 to May 2024 in three phases: Baseline (Jan-Dec 2022), Intervention (Jan-Dec 2023), and sustenance (Jan-May 2024). A QI team was formed and factors for reduced milk donation were identified. Interventions were planned in two PDSA (Plan Do study Act) cycles to improve awareness among mothers and staff nurses of postnatal (PN)-Postop ward regarding benefits of breastmilk, human milk bank, PDHM, increasing nutrition of mothers and to improve milk collection facilities. The monthly outcome measures were number of donors, average volume of milk collected, volume of milk disbursed, number of beneficiaries, the rate of exclusive breastfeeding, morbidities &amp; mortality in PN-Postoperative ward. Study variables of all three phases were analyzed using QI macros 2020. Results The mean (SD) monthly donated milk volume increased from 25.4L (2.5) in baseline to 40.0 L(2.4) and 39.3L (1.03) in intervention and sustenance phase respectively (P &lt; 0.0001). Milk disbursed to PN-Postop ward increased from 6.4L (1.1) in baseline phase to 13.1L(3.8) and 14.5L (0.54) in subsequent phases. Beneficiaries increased from 43(35-49.7) to 68(56.7-77) and 110 (105-120). Exclusive breastfeeding rates improved from 70% to 97% and 99%. Postnatal admissions due to sepsis, feed intolerance, or dehydration decreased from 25.5(23.7-26) to 5(4-6.2) and 5(5-5) after intervention (P &lt; 0.001). Mortality decreased from 0.049% in baseline to 0.016% in intervention phase. However, there were no deaths in sustenance phase (P = 0.011). Conclusion QI measures help to motivate more mothers to donate more milk. This improves number of beneficiaries and volume of milk disbursed to neonates in postnatal &amp; postoperative ward which improves their outcomes.

INDICATORS OF EXOCRINE PANCREATIC ACTIVITY UNDER CONDITIONS OF NUTRITIONAL DEFICIENCY IN PRETERM INFANTS OF DIFFERENT GESTATIONAL AGE

Nutritional deficiency in the postnatal period is observed in nearly 100% of preterm infants, which is attributed to hypoxic damage to the body and the functional immaturity of the digestive system. Timely diagnosis of nutritional intolerance requires an investigation of pancreatic enzymatic activity. Insufficient exocrine function of the pancreas negatively impacts the absorption of essential nutrients, potentially leading to growth and developmental deficiencies in the child and contributing to the development of functional and chronic diseases.The aim of this study was to analyze the indicators of exocrine pancreatic function in preterm infants, regarding the gestational age, in cases of severe perinatal pathology during the early neonatal period.Materials and methods. The study analyzed indicators of exocrine pancreatic function in preterm infants with enteral feeding intolerance and severe perinatal pathology. The participants were divided into four groups: Group I included 54 preterm infants with a gestational age of 29–31⁶ weeks; Group II comprised 67 infants born at 32–33⁶ weeks; Group III included 41 newborns with a gestational age of 34–36⁶ weeks; and Group IV consisted of 50 infants with a gestational age of 34–36⁶ weeks who had a satisfactory adaptation course. Inclusion criteria were gestational age of less than 37 weeks, severe condition at birth requiring primary resuscitation, signs of nutritional intolerance during the first week of life, and parental consent for participation. Additional laboratory methods included the assessment of pancreatic enzymatic activity: levels of amylase, lipase, trypsin, and leucine aminopeptidase in umbilical cord blood. The study was conducted at the Municipal Clinical Maternity Hospital No. 2 of the Chernivtsi City Council, the German-Ukrainian Laboratory "BUKINTERMED" (Chernivtsi, Ukraine), with the support of the Public Laboratory of Medicine, Microbiology, and Infectious Epidemiology (Cottbus, Germany).Results of the study. In the umbilical cord blood of newborns, a decrease in the levels of exocrine pancreatic enzymes, including amylase, lipase, trypsin, and leucine aminopeptidase, was observed. These levels correlated with the gestational age at birth. The obtained results confirm the peculiarities of pancreatic function in preterm infants and, to some extent, explain the mechanism of nutritional intolerance development under conditions of hypoxic damage in severe perinatal pathology.Conclusions: 1. The impairment of the functional state of the gastrointestinal system in preterm infants is multifactorial, with exocrine pancreatic insufficiency being one of its components.2. Clinical symptoms of nutritional deficiency include: regurgitation, stasis, flatulence, intestinal paresis, delayed passage of meconium and transitional stool, the presence of bile or blood in stools, as well as pain syndrome, which may be accompanied by bradycardia, apnea episodes, and decreased blood oxygen saturation.3. Laboratory criteria confirming exocrine pancreatic insufficiency, in correlation with decreased gestational age, include reduced levels of amylase, lipase, trypsin, and leucine aminopeptidase.

Sports Dietitians Australia and Ultra Sports Science Foundation Joint Position Statement: A Practitioner Guide to the Prevention and Management of Exercise-Associated Gastrointestinal Perturbations and Symptoms.

It is now well-established that exercise can disturb various aspects of gastrointestinal integrity and function. The pathophysiology of these perturbations, termed "exercise-induced gastrointestinal syndrome (EIGS)," can lead to exercise-associated gastrointestinal symptom (Ex-GIS) inconveniences. EIGS outcomes can impact physical performance and may lead to clinical manifestation warranting medical intervention, as well as systemic responses leading to fatality. Athlete support practitioners seek prevention and management strategies for EIGS and Ex-GIS. This current position statement aimed to critically appraise the role of EIGS and Ex-GIS prevention and management strategies to inform effective evidence-based practice and establish translational application. Intervention strategies with mostly consistent beneficial outcomes include macronutrient (i.e., carbohydrate and protein) intake and euhydration before and during exercise, dietary manipulation of fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP), and gut training or feeding tolerance adjustments for the specific management of Ex-GIS from gastrointestinal functional issues. Strategies that may provide benefit and/or promising outcomes, but warrant further explorations include heat mitigating strategies and certain nutritional supplementation (i.e., prebiotics and phenols). Interventions that have reported negative outcomes included low-carbohydrate high-fat diets, probiotic supplementation, pharmaceutical administration, and feeding intolerances. Owing to individual variability in EIGS and Ex-GIS outcomes, athletes suffering from EIGS and/or support practitioners that guide athletes through managing EIGS, are encouraged to undertake gastrointestinal assessment during exercise to identify underlying causal and exacerbation factor/s, and adopt evidence-based strategies that provide individualized beneficial outcomes. In addition, abstaining from prevention and management strategies that present unclear and/or adverse outcomes is recommended.

Abundance and Composition of the Meconium Microbiota in Preterm Infants with Infections, Feeding Intolerance, or Necrotizing Enterocolitis.

The role of the microbial flora of the gut of a newborn is of scientific and practical interest. The aim of this study was to assess the abundance and composition of the meconium microbiota in preterm infants with infections, feeding intolerance, or necrotizing enterocolitis (NEC). Eighty-four preterm infants born by cesarean section were prospectively enrolled in this study. Out of the 28 diseased infants, 23 developed infections, including 8 cases of sepsis, 10 cases of pneumonia, 1 case of enterocolitis, and 4 cases of NEC. Fifty-six (66.67%) preterm infants without these characteristics served as control group. General clinical information (gender, gestational age, birth weight, presence of preterm rupture of mem-branes, Apgar 1-minute score, and duration of hospitalization) was collected. First-pass meconium samples were collected for 16S rRNA microbiological analysis. Compared with the control group, the diseased infants had a lower gestational age (p < 0.001) and lower body weight (p = 0.014). In addition, the hospitalization time of the diseased infants was longer than that of the control group (p < 0.001). On the α-diversity measure, there was no difference in species abundance and diversity between the two groups; on the β-diversity measure, the differences in the microbial composition of the two groups were subjected to PCoA analyses, which showed that there was a difference between the disease group and the control group. At the phylum level, the dominant phylum in both groups was p_Proteobacteria, with higher abundance of p_Firmicutes in the disease group. At the genus level, the dominant genus in both groups was g_Novosphingobium. Microbiome phenotype prediction by BugBase revealed that microbial phenotypes 'Gram-positive' and 'Anaerobic' were abundantly increased in the disease group; microbial function prediction did not differ between the two groups in terms of significant function. The impact of infections, feeding intolerance, and NEC on a host is complex. Preterm infants delivered by cesarean section have p_Proteobacteria as the dominant phylum, with a higher abundance of p_Firmicutes in the disease group, a difference contributed by g_Peptoniphilus.

The Effects of "Oral Administration of Breast Milk Droplets" and "Palatal Stimulation with a Finger" Methods on Feed Tolerance in Preterm Newborns Fed via an Orogastric Tube: Randomized Controlled Trial.

Infants should be provided with effective feeding skills with evidence-based care practices to ensure nutritional tolerance and maximize the growth and development in preterm infants. This study aimed to examine the effects of "oral administration of breast milk droplets" and "palatal stimulation with a finger" methods on feed tolerance in preterm newborns fed via an orogastric tube. This randomized controlled trial was conducted in the neonatal intensive care unit of a private hospital. The study included 90 premature newborns born at the 28th-36th gestational weeks and admitted to intensive care. We applied breast milk droplets inside the oral cavity of newborns (30) in one of the intervention groups and stimulated the palate of newborns (30) by using a finger in the other. We performed these interventions every 3 hours for 5 minutes at the feeding times of the newborns for 7 days. Babies in the control group were not applied any intervention. We used SPSS (Statistical Package for Social Sciences) 22.0 for Windows software for statistical analyses. The number of defecations, frequencies of residuals, body weight, and abdominal circumference were significantly different between the groups (P < 0.05). The increments in body weight and reductions in abdominal circumference were significantly different between the groups in the study (P < 0.05). Palatal stimulation with a finger acted on feed tolerance more favorably than the oral administration of breast milk droplets or no intervention in preterm infants fed via OGT. We suggest primarily that palatal stimulation with a finger and secondarily the oral administration of breast milk droplets as the two methods to be employed to overcome feeding intolerance, which is a significant problem in premature infants.

Use of pectin-supplemented enteral nutrition in intensive care: a systematic review and meta-analysis.

Use of pectin-supplemented enteral nutrition in intensive care: a systematic review and meta-analysis.

Probiotic Supplements Effect on Feeding Tolerance, Growth and Neonatal Morbidity in Extremely Preterm Infants: A Systematic Review and Meta-Analysis.

Probiotic supplementation has been actively investigated in preterm populations to reduce the risk of necrotizing enterocolitis (NEC) and late-onset sepsis. Despite this, few studies have focused on clinically relevant feeding tolerance and growth outcomes, and there is an alarming lack of evidence surrounding extremely preterm infants (defined as birth before 28 weeks gestational age), those most at risk of severe comorbidities. We aimed to investigate whether probiotics improve feeding tolerance, neonatal growth and neonatal morbidity among extremely preterm infants. A literature search was conducted in Medline, Embase, Cochrane CENTRAL, Web of Science, and clinicaltrials.gov for ongoing trials. We included extremely preterm infants from randomized controlled trials and non-randomized trials with a concurrent control group. Two authors independently performed screening, data extraction and risk of bias assessment using the Risk of Bias 2 tool from Cochrane. The certainty of the evidence was assessed using GRADE. Eleven RCTs and three non-randomized studies with a concurrent control group were included, analyzing a total of 14,888 extremely preterm infants. Meta-analyses revealed lower mean days to full enteral feeds (mean difference 1.1 days lower; 95% CI, 7.83 lower to 5.56 higher) and lower duration of parenteral nutrition (mean difference 2.4 days lower; 95% CI, 7.44 lower to 2.58 higher) in infants treated with probiotics; however, this was not statistically significant. There was a significant reduction in NEC (RR; 0.80, 95% CI; 0.68, 0.93) and all-cause mortality (RR; 0.56, 95% CI; 0.33, 0.93) in the probiotic group. All outcomes were graded at low or very low certainty of evidence. The findings indicate a trend towards a potential beneficial effect of probiotic supplementation in reducing feeding intolerance and a notable reduction of risk of NEC and all-cause mortality in infants receiving probiotics. Future RCTs will focus on feeding intolerance, and growth outcomes are warranted.

Atypical Presentation of Duodenal Atresia in a Newborn With Trisomy 21: A Simulated Case Report and Narrative Review

Duodenal atresia has a strong association with chromosomal anomalies, particularly trisomy 21. Duodenal atresia is identified prenatally in up to 60% of cases, and intestinal obstructions often present with signs, including difficulty feeding, emesis (particularly in the first 24 to 48 hours of life), abdominal distension, and inability to pass meconium in the immediate postnatal period. In this article, we present a simulated case of a neonate with trisomy 21 who presented at age 2 weeks for evaluation of poor weight gain and feeding intolerance and was diagnosed with duodenal atresia. Imaging is the mainstay of diagnosis and imaging modalities, such as abdominal radiographs or upper gastrointestinal studies, will reveal a “double bubble” sign. This sign indicates proximal dilation of the duodenum and stomach, suggesting duodenal atresia. Management often involves surgical correction to bypass the obstruction and parenteral nutrition, as enteral feeds are often introduced slowly postoperatively. Early diagnosis and a collaborative multidisciplinary approach are vital to successful treatment. [ Pediatr Ann . 2025;54(4):e139–e143.]

Home Enteral Tube Feeding in Children and Young People: A Review of Current Literature on Optimum Frequency and Mode of Dietetic Assessment and Monitoring in the Community Setting.

Home enteral nutrition (HEN) is the provision of nutrition support administered via feeding tube designed to support growth and development when oral feeding is not possible. Post-hospital discharge, patients are provided with all necessary enteral feed and equipment for continued nutrition support in the community. Specialist HEN dietitians, typically undertake assessment and monitoring of growth, tolerance and correct administration of HEN within the community. However, national clinical guidelines specific to the assessment and monitoring of children in receipt of HEN do not exist. This review sought to identify current evidence on (1) optimum frequency of HEN dietetic reviews and (2) ideal mode of review, including explicit criteria on how this might alter based on the child's age, nutritional parameters and clinical condition. Two electronic databases, CINAHL and Medline were screened to identify relevant articles published between February 2006 and June 2022 that met the inclusion criteria, using a PEO (population, exposure, outcome) search strategy. The search yielded 1677 articles, these were screened by title, abstract and full text for suitability for inclusion within the final review. A total of 1674 articles were excluded, yielding three articles considered suitable for this review. Recommendations on frequency and mode of assessment and monitoring of this patient group varied between the three articles. There was a lack of consensus on 'ideal' dietetic care, and explicit guidance on how this may alter based on clinical presentation was not provided. There is a paucity of evidence on the most effective and efficient assessment and monitoring of children in receipt of HEN. Evidence-based and person-centred clinical guidelines are needed to inform commissioners and healthcare professionals on the optimum monitoring of this patient group. Future research should explore children, family and clinician expectations and needs, with pertinence to patient age and primary diagnosis, type and adequacy of feed used, feed tolerance, tube-related complications and treatment, hydration status, biochemical monitoring, the use of telehealth platforms, obtaining anthropometric measurements and the effects of drug/nutrient interactions.

A Study on the Clinical Effect of Chiropractic Combined with Acupoint Therapy in Preventing Feeding Intolerance in Very Low Birth Weight Infants

Objective: To explore the effect of chiropractic combined with acupoint therapy in preventing feeding intolerance in very low birth weight infants (VLBWI). Methods: A total of 98 VLBWI admitted in the Neonatal Intensive Care Units (NICU) from July 2022 to February 2023 were randomly divided into the control group (n=49) and the experimental group (n=49). The control group received conventional Western medical treatment and care, while the experimental group were given chiropractic combined with acupoint therapy. The incidence of feeding intolerance, complications, duration of full oral feeding, meconium evacuation time, length of hospital stay, and weight gain werecompared between the two groups. Results: The incidence of the feeding intolerance and associated complications in the experimental group were significantly lower than those of the control group (P&lt;0.05). The duration of full oral feeding, meconium evacuation time, hospital stay in the experimental group were significantly shorter than those of the control group (all P&lt;0.05).The weight gain in the experimental group was higher than that of the control group (P&lt;0.05). Conclusion: Chiropractic combined with acupoint therapy can effectively prevent feeding intolerance and its associated complications, expedite the transition to full oral feeding, promote meconium evacuation, reduce hospital stay, and enhance the growth and development of VLBWI.

The Impact of Probiotics on Gut Health and the Treatment of Irritable Bowel Syndrome in Neonates

The research paper explored that neonates who are admitted to the neonatal intensive care unit [NICU] often face feeding intolerance and gastrointestinal due to gut immaturity and microbial imbalances. Probiotics have emerged as a promising intervention to improve gut health, enhance feeding tolerance, and reduce gastrointestinal disorders like necrotizing enterocolitis [NEC]. The study investigated the influence of probiotic supplementation on neonatal gut function and feeding outcomes. The study was conducted with 100 neonates admitted to the NICU and divided into two groups intervention and control. The intervention group receives the probiotic and the control group receives only standardized care for feeding. The findings demonstrate that neonates who received the probiotics improved the feeding tolerance, and reduced vomiting and reflux as compared to the feeding in the controlled group. Additionally, probiotic supplementation was linked with a lower incidence of feeding-related complications which suggests its potential role in improving neonatal digestive health. Despite the positive effects the study demonstrates the limitations of sample sampling and needs further research to address the limitations.

Thinking beyond sepsis to unmask a metabolic mystery: a rare case of neonatal maple syrup urine disease

Maple syrup urine disease (MSUD) was first reported by paediatrician Menkes in 1954, as the α-ketoacid excreted in urine smells like maple syrup. MSUD is a rare genetic disorder which manifested as impaired branched-chain amino acid (BCAA) metabolism caused by branched-chain α-ketoacid dehydrogenase (BCKD) complex deficiency. Early diagnosis and treatment of MSUD is important for better outcomes. Feed intolerance, history of consanguinity between parents and that peculiar odour of maple syrup in urine should raise suspicion of the above. Timely referral, especially by clinicians practising in rural areas, is essential for early diagnosis and treatment. We present a case of MSUD with poor prognosis probably due to advanced disease at the time of presentation. The case highlights the importance of suspicion and early diagnosis of MSUD, as well as thinking beyond sepsis as the root of all problems.

The Role of Endoscopy in the Postoperative Management of Patients Treated for Esophageal Atresia: 20 Years of Experience.

Background/Objectives: Endoscopy plays a well know role in managing patients treated for esophageal atresia (EA), allowing the detection and treatment of complications such as anastomotic strictures, gastroesophageal reflux disease, and other structural abnormalities, during the critical first year of life. Nevertheless, we would like to underline the importance of endoscopy early in the follow-up of patients treated for EA, as recommended by guidelines. This study evaluates the role of endoscopy in managing patients treated for esophageal atresia (EA), focusing on the detection and treatment of complications such as anastomotic strictures, gastroesophageal reflux disease, and other structural abnormalities during the critical first year of life. Methods: A retrospective analysis was conducted over 20 years at our institution. Clinical assessments were performed at 3, 6, and 9 months to monitor growth, feeding tolerance, and proton pump inhibitor (PPI) adjustments. Endoscopic evaluations were conducted under general anesthesia around one year of age. Results: Between 2003 and 2023, 84 patients underwent surgical treatment for EA, with complete follow-up data available for 77 patients. Complications occurred in 21 patients (27%), including 4 patients (5.5%) with isolated anastomotic stricture, 8 patients (10%) with reflux esophagitis, 8 patients (10%) affected by both stenosis and reflux, and 1 case (1.5%) of fistula recurrence. Endoscopic dilatations for stenosis were successful, averaging three procedures per patient. Growth parameters were normal in 91% of cases by the first year. Conclusions: Esophagogastroscopy is a safe and effective tool for diagnosing and managing complications after EA repair in infants. The minimally invasive procedure could allow early detection of esophagitis and strictures, offering significant therapeutic benefits. Given these important results, we would like to recommend its use in routine follow-up care.