Incidence Of Feeding Intolerance Research Articles

Transabdominal gastro-intestinal ultrasonography (TGIU) for predicting feeding intolerance in critically ill patients: A prospective observational study

This study aimed at verifying the feasibility of transabdominal gastro-intestinal ultrasonography (TGIU) for predicting feeding intolerance (FI). This single-center prospective observational study comprising critically ill patients who were admitted to an intensive care unit (ICU) and received enteral nutrition through a nasogastric tube. TGIU parameters including gastric antral cross-sectional area (CSA) and acute gastrointestinal injury ultrasonography (AGIUS) score, were conducted on days 1, 3, 5, and 7 within the first week of starting enteral nutrition (EN). A total of 91 patients were eligible for inclusion and 57 showed FI. The incidence of FI was 28.6%, 41.8%, 29.7%, and 27.5% on days 1, 3, 5, and 7, respectively, and the incidence of FI was 62.6% within the first week of starting EN. Univariate logistic regression analysis showed that SOFA score, CSA, and AGIUS score, were significantly (P<0.05) associated with the FI on the same day. In the multivariate analysis including two variables, CSA, and AGIUS score were found to remain independent predictors for FI and 28-day mortality. An area under the curve (AUC) for TGIU predicted FI in the first week of starting EN (the cut-off of CSA ≥6.0cm2 yielded a sensitivity of 86.0% and specificity of 79.4%, and for AGIUS score ≥3.5 yielded a sensitivity of 87.7% and specificity of 82.4%). The predictive value of TGIU for 28-day mortality was higher than the SOFA score [0.827 (0.733-0.921) vs. 0.646 (0.519-0.774), P=0.001]. TGIU represented an effective means for predicting FI and 28-day mortality in critically ill patients. These results supported the hypothesis that persistent FI in critically ill patients is an essential determinant for poor prognosis.

The dilemma of feeding during the treatment of patent ductus arteriosus with oral ibuprofen in preterm infants ≤30 weeks of gestation-a randomized controlled trial.

To evaluate the effect of minimal enteral feeding (MEN) versus withholding feeding on time to reach full feeds during treatment of hs-PDA with oral ibuprofen in infants ≤30 weeks. We performed a single-center, randomized control trial of 126 premature infants born ≤30 weeks gestation, <7 days of age with hs-PDA comparing continuation of MEN (n = 64) vs no feeding (n = 62) during treatment. The primary outcome was time to reach a feed volume of 150 ml/kg/day. Secondary outcomes included were episodes of feed intolerance, GI bleed, NEC and other comorbidities. There was no difference in the time to reach full feeds - median age of 16 days in both groups (p = 0.573). Incidence of feed intolerance, NEC and other secondary outcomes were also similar in both groups. Continuing MEN during treatment of hs-PDA with oral ibuprofen does not decrease time to reach full enteral feeds in very preterm infants.

Incidence and Risk Factors of Feeding Intolerance in Adult Patients Given Enteral Nutrition Therapy After Liver Transplant

This study aimed to describe the occurrence of feeding intolerance (FI) in adult patients given enteral nutrition (EN) during the first week after liver transplant and investigate the risk factors of FI. A total of 320 adult patients were enrolled and the incidence of FI was 50.3%. There are 5 independent risk factors for FI in these patients: average EN infusion rate, length of time to initiate EN, use of mechanical ventilation, use of sedatives or analgesics, and intraoperative fluid balance. Appropriate EN regimens and clinical treatments should be taken into consideration to prevent FI for these patients.

Early versus delayed enteral nutrition for neonatal hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia: a randomized controlled trial

BackgroundThe practice of therapeutic hypothermia (TH) is widely used for neonatal hypoxic-ischemic encephalopathy (HIE) despite its corresponding feeding strategies are still controversial. This randomized controlled trial (RCT) demonstrated to evaluate the effect of early vs. delayed enteral nutrition on the incidence of feeding intolerance (FI) and other association during TH.MethodsThis single center, parallel-group, and no-blinded RCT was processed in a level III, and academic neonatal intensive care unit. Infants who were diagnosed with HIE and undertaken TH from September 2020 to August 2021 were enrolled. Participants were randomized to receive enteral nutrition either during TH/rewarming (early enteral nutrition, EEN) or after TH (delayed enteral nutrition, DEN) according to a recommend enteral feeding protocol. All data were analyzed using SPSS 26.0 software with a p-value< 0.05 was considered statistically significant.ResultsNinety-two infants were enrolled after randomization, but 12 (13.04%) cases including 3 (3.26%) deaths were excluded from eventually analyzed, who did not initiate or discontinue the intervention. 80 cases (42 and 38 in the EEN and DEN group, respectively) who completed the interventions were eventually analyzed. Besides initial time of enteral feeds, two groups had processed the same feeding method. Total 23 (25.0%) cases developed FI, and no difference of morbidity was found between two groups (23.4% vs 26.7%, p = 0.595; Log Rank, p = 0.803). There was no case died or developed late-onset bloodstream and no difference of the incidence of hypoglycemia or weight gain was found (p > 0.05). The percentage of infants who had not reaching the goal of full enteral feeding volume between the two groups was similar (21.43% vs 23.68%, p = 0.809). The average time of parenteral nutrition, reaching full enteral feeds and hospital stay were shorter in the EEN group compared with the DEN group with significant differences (8.81 ± 1.67 vs 10.61 ± 2.06 days, p < 0.001; 9.91 ± 1.88 vs 12.24 ± 2.50 days, p < 0.001; 12.55 ± 4.57 vs 16.47 ± 5.27 days, p = 0.001 respectively).ConclusionsCompared with delayed enteral nutrition, introduction of early enteral nutrition according to a recommend feeding strategy for neonatal HIE undergoing TH may be feasible and safe.FI is frequent in this high-risk group of infants which should not be ignored during feeding process.Trial registrationThe Chinese Clinical Trial Registry,ChiCTR2000038193, 2020-9-13, https://www.chictr.org.cn.

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Rapid versus Slow Feeding Advancement in Preterm Low Birth Weight Neonates: A Systematic Review and Meta-analysis

Objectives. To compare the clinical outcomes of rapid versus slow enteral feeding advancement in preterm low birth weight neonates.&#x0D; Methods. Searches for randomized controlled trials evaluating the effect of rapid versus slow rate of enteral feeding advancement on the clinical outcomes of preterm, low birth weight neonates were performed in different databases. Two authors screened the articles for inclusion and statistical analysis was done using Review Manager Version 5.3 (RevMan) software.&#x0D; Results. Six trials with a total of 680 subjects comparing enteral feeding advancement protocols were identified. The number of days to reach full feeds in rapid enteral feeding was shorter by 2.79 days (95% CI 1.39, 4.19) and time to regain weight by 3.72 days (95% CI 2.86, 4.59) compared to slow enteral feeding. There was no significant difference in the incidence of feeding intolerance (OR 0.69, 95% CI 0.42, 1.11) and NEC (OR 0.88, 95% CI 0.45, 1.72) between the two groups.&#x0D; Conclusions. Rapid enteral feeding protocols reduce the time to establish full enteral feeds and to regain birth weight in preterm low birth weight neonates. Rapid enteral feeding may facilitate early discharge and help reduce hospital costs for the care of these neonates.

A randomized controlled trial of abdominal massage and prone positioning as a proactive nursing strategy for feeding intolerance among preterm with non-invasive ventilation

Background: Feeding intolerance among preterm infants is a significant contributing factor to their prolonged hospitalization in the neonatal intensive care unit. This condition is further exacerbated by the use of noninvasive ventilation. The aim of this study is to examines the effectiveness of utilizing abdominal massage and prone positioning on the incidence of feeding intolerance in preterm infants receiving noninvasive ventilation in the neonatal intensive care unit. The study employed a randomized controlled trial with an equivalent control group pretest and posttest design to investigate the subject matter. The research was conducted in the neonatal intensive care unit affiliated with the Specialized Pediatric Hospital in Benha city, Egypt. The research was carried out on a sample of 75 premature infants, divided into three groups: 25 subjects who received abdominal massage, 25 who were placed in a prone position, and 25 who served as a control group. The study monitored feeding intolerance parameters, including gastric residue, abdominal distension, and vomiting, on both the first (pre) and seventh (post) days. The findings indicate a statistically significant distinction (P≤ 0.001) between the first and seventh day of the trial in both the abdominal massage group and prone positioning group, as compared to the control group, in relation to the feeding intolerance parameter. This was evidenced by an increase in defecation frequency, a reduction in gastric residue, a decrease in vomits and regurgitations, a relief in abdominal distention, an absence of bradycardia, and a decrease in abdominal circumference. Furthermore, a significant positive correlation was observed between the application of abdominal massage and the utilization of prone positioning in relation to the parameter of feeding intolerance. In conclusion, the study found that the implementation of abdominal massage and prone positioning had a significant impact on the incidence of feeding intolerance in preterm infants receiving noninvasive ventilation. As a result, the author recommends that nursing professionals consider these interventions as proactive measures for addressing feeding intolerance in this preterm.

Probiotics (Bacillus clausii) for Prevention of Late-onset Sepsis in Preterm Infants (&lt;34 weeks): A Randomised Controlled Trial

Introduction: Late-onset Sepsis (LOS) causes significant morbidity and mortality in preterm infants. Probiotics have been suggested to improve the integrity of mucosal barrier by modifying the enteric microflora and suppress the overgrowth and translocation of pathogens in the gut, thus preventing life- threatening infections. Although probiotics have a definite role in prevention of Necrotising Enterocolitis (NEC) in preterm neonates, their effect on prevention of LOS in preterm neonates is still uncertain. Aim: To evaluate the role of probiotics in reducing incidence of LOS in preterm neonates (&lt;34 weeks). Materials and Methods: A double blinded randomised control trial was conducted in a tertiary care Neonatal Intensive Care Unit (NICU) in Karnataka, India between 1st January 2019 to 31st December 2019. Seventy haemodynamically stable preterm neonates, &lt;34 weeks of Gestational Age (GA), were randomised into ‘Probiotic’ and ‘Placebo’ groups. The probiotic group (n=36) was prophylactically administered Bacillus clausii suspension at a dose of 2.5 mL per-oral (0.4×109 spores in 1 mL) BD with breast milk, from initiation of enteral feeds till seven days, discharge/ death/LOS, whichever was earlier. The placebo group (n=34) received breast milk with sterile water 2.5 mL per- oral BD. All the neonates were investigated and managed as per standard hospital protocol. Primary outcome of the study was to find the incidence of LOS. Student’s t-test, Mann-Whitney U test, Chi-square test and Fisher’s exact test were used for statistical analysis. Results: There was no significant difference between the probiotic vs placebo group, with respect to incidence of LOS (11.11% vs 17.64%; (p&gt;0.05)) and duration of hospital stay (10.86±3.19 vs 11.23±2.98 days; (p&gt;0.05)). However, incidence of feed intolerance in the probiotic group (11.11%) was significantly less than that the other (26%) (p&lt;0.05). Conclusion: Probiotics, prophylactically fed enterally, did not reduce the incidence of LOS but provide a promising strategy to prevent feed intolerance in premature neonates.

A Comparison between Continuous Indirect Calorimetry and Single Weight-Based Formula in Estimating Resting Energy Expenditure in Nutritional Therapy: A Prospective Randomized Controlled Study in Critically Ill Patients

Optimal nutritional therapy is important to improve outcome in critically ill population in an intensive care unit (ICU). Although indirect calorimetry (IC) is currently a gold standard for resting energy expenditure (REE) measurement, yet it is still not routinely used in the ICU. A total of 146 mechanically ventilated patients were randomised to receive enteral nutrition (EN) with energy targeted based on continuous indirect calorimetry (IC) measurements (IC group, n=73) or according to 25 kcal/kg/day (SWB group, n=73). Patient characteristics were equally distributed and the IC group showed lower mean measured REE (1668.1 + 231.7 vs 1512.0 + 177.1 kcal, p&lt;0.001). Results also showed a significant deficiency in the daily (-148.8 + 105.1 vs. -4.99 + 44.0 kcal, p&lt;0.001) and total cumulative energy balances (-1165.3 + 958.1 vs. 46.5 + 369.5 kcal, p&lt;0.001) in the SWB group as compared to the IC group. From the Kaplan-Meier survival analysis, we found that ICU mortality was significantly lower in the IC group with better survival probability compared to the SWB group (log-rank test, p = 0.03). However, both groups showed comparable results in terms of ICU length of stay, duration of mechanical ventilation and incidence of feeding intolerance. In conclusion, this study showed that tightly supervised nutritional therapy based on continuous IC measurement provides significantly less mean daily and cumulative energy deficits as well as significantly reduced ICU mortality rate.

Dual X-Ray Image under Neural Network Adopted in Comparison of Efficacy and Safety of Deep Hydrolyzed Protein Milk Powder and Parenteral Nutrition in Intervention of Neonatal Noninfectious Abdominal Distension

Objective. The aim of this study was to explore the application value of double X-ray image based on neural network in comparison of the efficacy and safety of deep-water proteolytic milk powder and parenteral nutrition in the intervention of neonatal noninfectious abdominal distention. Methods. Clinical data of 58 neonates diagnosed with noninfectious abdominal distention were retrospectively analyzed. 2D-3D registration was simplified into two steps by decomposing spatial rigid-body transformation parameters into two planes, including 2D-2D approximate rigid-body registration and single-parameter 2D-3D rigid-body registration. Then, the convolution neural network was used to fit the nonlinear mapping relationship between the residual of X-ray images and the corresponding attitude differences of children, and the residual regression spatial rigid-body transformation parameters of the X-DRR image pairs were obtained. Noninfectious abdominal distention was diagnosed in all neonates, of which 28 neonates were treated with deep hydrolyzed protein milk powder. Another 30 neonates who received parenteral nutrition support were set as control group. All newborns received two weeks of treatment. The total effective rate, birth weight recovery, weight growth rate, intestinal feeding recovery time, and incidence of feeding intolerance were compared between the two groups. Results. Spatial coordinate decomposition using double X-ray can simplify the mapping relationship between spatial coordinate transformation and X-DRR residual image. Compared with the gray level iterative optimization registration algorithm, the registration accuracy and speed were significantly improved. The total effective rate in the treatment group (92.86%) was significantly higher than that in the control group (9%). The recovery time of birth weight, intestinal feeding recovery time, and meconium excretion time were significantly shorter than those in the control group, and the body weight in the treatment group increased faster than that in the control group ( P &lt; 0.05 ). In addition, the incidence of feeding intolerance was 3.57% (1/28) in the treatment group and 36.36% (8/22) in the control group, which was significantly lower than that in the treatment group ( P &lt; 0.05 ). Conclusion. After data training, the network can complete accurate double ray registration in 0.04 s. Deep hydrolyzed protein milk powder had remarkable therapeutic effect on neonates, with no infective abdominal distention, fast recovery, and low incidence of feeding intolerance, which was safe and reliable in clinical application.

Analysis on the Application Effect of Abdominal Acupoint Massage on Feeding Intolerance in Premature Infants.

Objective Breast milk is the best food for newly born infants because it is more digestible and can relieve infants' gastrointestinal burdens. The purpose of this study was to investigate the application effect of abdominal acupoint massage on feeding intolerance in premature infants. Methods A total of 50 premature infants with feeding intolerance admitted to our hospital from January 2018 to October 2019 were selected and randomly divided into the control group (n = 25) and the experimental group (n = 25). Among them, the premature infants in the control group received routine therapy, while based on the treatment in the control group, the premature infants in the experimental group were treated with abdominal acupoint massage. After that, the incidence of feeding intolerance, MNA nutritional status score, body mass, development state, length of hospital stay, and response rate were all compared between the two groups to analyze the application effect of abdominal acupoint massage on feeding intolerance in premature infants. Results The incidence of feeding intolerance of the premature infants in the experimental group was significantly lower than that in the control group, with statistically significant differences (P < 0.05); the MNA nutritional status scores of the premature infants in the experimental group were significantly higher than those in the control group, with statistically significant differences (P < 0.05); the body mass and development state of the premature infants in the experimental group were significantly better than those in the control group, with statistically significant differences (P < 0.05); the length of hospital stay of the premature infants in the experimental group was significantly shorter than that in the control group, with statistically significant differences (P < 0.05); the response rate in the experimental group was significantly higher than that in the control group, with statistically significant differences (P < 0.05). Conclusions Abdominal acupoint massage therapy can significantly reduce the incidence of feeding intolerance, shorten the length of hospital stay, and improve nutritional status, development state, and response rate in premature infants, with obvious therapeutic effect, which is worthy of application and promotion in clinical practice.

Effects of different feeding intervals on the feeding outcomes of infants who underwent surgical repair of ventricular septal defects.

The objective of the present study is to explore the effect of different feeding intervals on the feeding outcomes of infants who underwent ventricular septal defect (VSD) closure. This study is a prospective, randomized controlled trial conducted by a provincial hospital in China. According to different feeding intervals, 78 eligible participants were randomly divided into Group A (2-h interval, n = 39) and Group B (3-h interval, n = 39). The basic clinical data, total feeding time, incidence of feeding intolerance, and nurse job satisfaction scores of the two groups were collected. The total feeding time in Group A was significantly longer than that in Group B (142.5 ± 15.4 vs. 132.0 ± 16.1 min/d, p = .020). The nurse job satisfaction scores in Group A were significantly lower than those in Group B (101.7 ± 9.8 vs. 108.8 ± 10.1, p = .005). There were no significant differences in the duration of mechanical ventilation (3.7 ± 1.1 vs. 3.9 ± 1.0 d, p = .272), length of ICU stay (4.5 ± 1.1 d vs. 4.7 ± 0.9 d, p = .451), or length of hospital stay (13.2 ± 1.4 vs. 13.3 ± 1.0 d, p = .642) between the two groups. Although the incidence of feeding intolerance in Group A was slightly lower than that in Group B, the difference was not statistically significant. Feeding at an interval of 2 or 3 h has no significant effect on the feeding outcomes of infants, and feeding at intervals of 3 h can reduce nurses' workload and improve nursing job satisfaction.

Comparison of sequential feeding and continuous feeding on the blood glucose of critically ill patients: a non-inferiority randomized controlled trial.

Background:Glucose control is an important aspect in managing critically ill patients. The goal of this study was to compare the effects of sequential feeding (SF) and continuous feeding (CF) on the blood glucose of critically ill patients.Methods:A non-inferiority randomized controlled trial was adopted in this study. A total of 62 patients who were fed enteral nutritional suspension through gastric tubes were enrolled. After achieving 80% of the nutrition target calories (25 kcal·kg−1·day−1) through CF, the patients were then randomly assigned into SF and CF groups. In the SF group, the feeding/fasting time was reasonably determined according to the circadian rhythm of the human body as laid out in traditional Chinese medicine theory. The total daily dosage of the enteral nutritional suspension was equally distributed among three time periods of 7 to 9 o’clock, 11 to 13 o’clock, and 17 to 19 o’clock. The enteral nutritional suspension in each time period was pumped at a uniform rate within 2 h by an enteral feeding pump. In the CF group, patients received CF at a constant velocity by an enteral feeding pump throughout the study. Blood glucose values at five points (6:00/11:00/15:00/21:00/1:00) were monitored and recorded for seven consecutive days after randomization. Enteral feeding intolerance was also recorded. Non-inferiority testing was adopted in this study, the chi-square test or Fisher test was used for qualitative data, and the Mann-Whitney U test was used for quantitative data to determine differences between groups. In particular, a repeated measure one-way analysis of variance was used to identify whether changes in glucose value variables across the time points were different between the two groups.Results:There were no significant demographic or physiological differences between the SF and CF groups (P > 0.050). The average glucose level in SF was not higher than that in CF (8.8 [7.3–10.3] vs. 10.7 [9.1–12.1] mmol/L, Z = −2.079, P for non-inferiority = 0.019). Hyperglycemia incidence of each patient was more common in the CF group than that in the SF group (38.4 [19.1–63.7]% vs. 11.8 [3.0–36.7]%, Z = −2.213, P = 0.027). Hypoglycemia was not found in either group. Moreover, there was no significant difference during the 7 days in the incidence of feeding intolerance (P > 0.050).Conclusions:In this non-inferiority study, the average blood glucose in SF was not inferior to that in CF. The feeding intolerance in SF was similar to that in CF. SF may be as safe as CF for critically ill patients.Trial RegistrationClinicalTrials.gov, NCT03439618; https://clinicaltrials.gov/ct2/show/record/NCT03439618

Effect of WeChat follow-up education on breastfeeding efficiency of infants after congenital cardiac surgery and parents' satisfaction: A short-term follow-up study.

This study aimed to investigate the impact of WeChat follow-up education on infants' breastfeeding efficiency after congenital cardiac surgery and parents' satisfaction. A prospective study was conducted in a provincial hospital in China. Sixty participants were divided into two groups: 30 participants in the study group received WeChat follow-up health education, and 30 participants in the control group received postoperative routine nursing education for infants after congenital cardiac surgery. The infants' breastfeeding efficiency, parents' satisfaction and relevant clinical data were recorded and analysed. After the WeChat follow-up intervention, the breastfeeding efficacy score, the parents' satisfaction score and the exclusive breastfeeding rate in the study group were significantly higher than those in the control group (P < 0.05). There was no significant difference in the incidence of feeding intolerance, abdominal distension, dyspeptic diarrhoea, weight gain or recurrent vomiting between the two groups during the 3-month follow-up period. WeChat education can improve infants' breastfeeding efficiency after congenital cardiac surgery and can improve parents' satisfaction and exclusive breastfeeding rate during the short-term follow-up period.

Performance of remote health education via WeChat to improve the pre-operative nutritional status of infants with non-restrictive ventricular septal defects: A prospective randomised controlled study.

This study aimed to explore the effect of performing remote health education via WeChat to improve the pre-operative nutritional status of non-restrictive ventricular septal defects (VSD). A prospective randomised controlled study was conducted in a provincial maternity and child hospital in China. Participants were randomised regarding education to the intervention group (WeChat) and the control group (leaflets). The nutritional status and complications of the patients were compared after intervening for 1month. Nutrient status comparison at 1month after intervention showed that the body weight, head circumference, haemoglobin, albumin and pre-albumin of the WeChat group were significantly higher than those of the leaflet group (P < 0.05). The STRONGkids score of the WeChat group was significantly lower than that of the leaflet group (P < 0.05). The incidence of feeding intolerance and respiratory tract infection in the WeChat group was significantly lower than that found in the leaflet group (P < 0.05). There was no significant difference in the incidence of liver insufficiency and jaundice between the two groups (P > 0.05). Providing pre-operative feeding and care guidance for parents of infants with non-restrictive VSD, via remote health education through WeChat, can effectively improve nutritional status and reduce the risk of malnutrition and feeding complications.

The Effects of Early Oropharyngeal Administration of Microdosed Colostrum on Feeding Status in Ventilated Extremely Low-Birth-Weight Infants.

Background: For extremely low-birth-weight infants (ELBWIs), mechanical ventilation and total parenteral nutrition are generally required in the early stages and lose the protective effect of early gastrointestinal nutrition of colostrum. We conducted a prospective randomized controlled trial to explore the effectiveness of early colostrum oropharyngeal administration on the feeding status of ELBWIs on mechanical ventilation. Materials and Methods: We randomly divided mechanically ventilated ELBWIs into an intervention group and a control group. In the intervention group, we provided oropharyngeal administration of colostrum during mechanical ventilation. The first colostrum oropharyngeal administration ended within 24 hours of birth. In the control group, we gave colostrum only for gastrointestinal nutrition, and other interventions were the same as for the intervention group. We collected the 1st and 6th day of life airway secretions and urine specimens from both groups. We recorded feeding status, including corrected gestational age at onset of enteral nutrition, corrected gestational age of no gastric retention during feeding, corrected gestational age of full enteral nutrition, corrected gestational age of sucking began, and corrected gestational age of per oral feeding. We also recorded growth of body mass, the incidence of feeding intolerance, and necrotizing enterocolitis (NEC). Results: On the 6th day of life, concentrations of secretory immunoglobulin A, and lactoferrin in airway secretions and urine of the intervention group were significantly higher than those of the control group (p < 0.05). The intervention group showed younger corrected gestational age of no gastric retention during feeding, corrected gestational age of full enteral nutrition, the corrected gestational age of sucking began and per oral feeding than those in the control group (p < 0.05). The day of recovery to birth weight was earlier than those in the control group (p < 0.05). The rate of feeding intolerance and NEC incidence in the intervention group was significantly lower than in the control group (p < 0.05). Conclusions: Early oropharyngeal administration of colostrum improves immune function of the gastrointestinal tract and the systemic anti-infective capability in ELBWI on mechanical ventilation, promoting the maturity of gastrointestinal function, improving feeding condition, and reducing the risk of feeding intolerance and NEC.

Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates

Fortification of expressed breast milk (EBM) using commercially available human milk fortifiers (HMF) increases short-term weight and length in preterm very low-birth-weight (VLBW) neonates. However, the high cost and increased risk of feed intolerance limit their widespread use. Preterm formula powder fortification (PTF) might be a better alternative in resource-limited settings. To demonstrate that fortification of EBM by preterm formula powder is noninferior to fortification by HMF, in terms of short-term weight gain, in VLBW neonates. Open-label, noninferiority, randomized trial conducted from December 2017 to June 2019 at a level 3 neonatal unit in India. The trial enrolled preterm (born at or before 34 weeks of gestation) VLBW neonates receiving at least 100 mL/kg/d of feeds and consuming 75% of milk or more as EBM. Neonates were randomly assigned to receive fortification by either PTF or HMF. Calcium, phosphorus, iron, vitamin D, and multivitamins were supplemented in PTF and only vitamin D in the HMF group to meet the recommended dietary allowances. The primary outcome was the weight gain until discharge from the hospital or 40 weeks' postmenstrual age, whichever was earlier; the prespecified noninferiority margin was 2 g/kg/d. Secondary outcomes included morbidities such as necrotizing enterocolitis, feed intolerance, and extrauterine growth restriction (<10th percentile on the Fenton chart at 40 weeks' postmenstrual age). Of the 123 neonates enrolled, 60 and 63 were randomized to the PTF and HMF groups, respectively. The mean gestation (30.5 vs 29.9 weeks) and birth weight (1161 vs 1119 g) were comparable between the groups. There was no difference in the mean (SD) weight gain between the PTF and HMF groups (15.7 [3.9] vs 16.3 [4.0] g/kg/d; mean difference, -0.5 g/kg/d; 95% CI, -1.9 to 0.7). The lower bound of 95% CI did not cross the noninferiority margin. The incidence of feed intolerance was lower in the PTF group (1.4 vs 6.8 per 1000 patient-days; incidence rate ratio 0.19; 95% CI, 0.04 to 0.95), and fewer neonates required withholding of fortification for 24 hours or more (5% vs 22%; risk ratio, 0.22; 95% CI, 0.07 to 0.75). The incidence of necrotizing enterocolitis stage II or more (0 vs 5%) and extrauterine growth restriction (73% vs 81%) was comparable between the groups. Fortification with preterm formula powder is not inferior to fortification with human milk fortifiers in preterm neonates. Given the possible reduction in feed intolerance and lower costs, preterm formula might be a better option for fortification, especially in resource-restricted settings. Clinical Trial Registry, India Identifier: CTRI/2017/11/010593.

Hunger-Based Versus Conventional Oral Feeding in Moderate and Severe Acute Pancreatitis: A Randomized Controlled Trial.

BackgroundThe length of hospitalization is prolonged in patients with acute pancreatitis due to delay in feeding. The present study aimed at evaluating hunger-based early feeding for its efficacy in reducing length of hospitalisation.Aims and MethodsThis was a parallel arm superiority randomized control trial. Patients with moderate and severe acute pancreatitis were randomised into hunger-based feeding and conventional feeding groups. Patients in hunger-based feeding group commenced feeding once they felt hungry and in conventional feeding group after normalization of biochemical parameters and resolution of symptoms. Patients were followed up till their discharge and were analyzed for length of hospitalisation, fasting duration, feed intolerance, incidence of infective morbidities and invasive procedures.ResultsHunger-based feeding and conventional feeding group included 56 and 54 patients, respectively. Hunger-based feeding led to a decrease in length of hospitalization (6.3 days in hunger-based feeding vs 7.3 days in conventional feeding group, P = 0.041) and fasting duration (1.6 days in hunger-based feeding vs 2.7 days in conventional feeding group, P = 0.001).The incidence of feed intolerance (P = 0.098), infective morbidities and invasive non-surgical procedures were similar in both the groups.ConclusionHunger-based feeding significantly reduces length of hospitalization and fasting duration in cases of moderate and severe acute pancreatitis without any significant rise in the incidence of complications.Registration number of Clinical Trails Registry India CTRI/2019/01/017,144.

Gastric Lavage for Prevention of Feeding Intolerance in Neonates Delivered Through Meconium-Stained Amniotic Fluid: A Systematic Review and Meta-Analysis

The role of gastric lavage in neonates delivered through meconium-stained amniotic fluid remains unclear. This study evaluated the effects of gastric lavage, compared to no gastric lavage, on the incidences of feeding intolerance, respiratory distress, meconium aspiration synd-rome, time to establish breastfeeding, hospitalization and pro-cedure-related complications in late-preterm and term neonates delivered through meconium-stained amniotic fluid. Systematic review and meta-analysis. MEDLINE, EMBASE, CENTRAL, and other databases were searched for randomized controlled trials and quasi-randomized controlled trials using search terms: neonate OR newborn infant, meconium OR meconium-stained amniotic fluid, and lavage OR gastric lavage from inception to May 2020. Data were pooled in RevMan and analyzed in GRADE. Pooled effects (9 randomized controlled trials, number=3668), showed a significant reduction in the incidence of feeding intolerance (relative risk 0.70; 95% confidence interval 0.58,0.85, I2=0) after gastric lavage. No difference was observed for the incidence of meconium aspiration syndrome (4 studies) or procedure-related complications (7 studies). Only one study, reporting the proportion of neonates with low oxygenation (SpO2<85%), did not find any significant difference. No study evaluated the effects of gastric lavage on respiratory distress, breastfeeding, and hospitalization. Low-quality evidence supported the role of gastric lavage for the prevention of feeding intolerance in late-preterm and term neonates born through meconium-stained amniotic fluid. Applicability of results was limited by the high risk of bias. Well-conducted randomized controlled trials with important patient outcomes are needed before recommending the practice of gastric lavage.

Feeding intolerance and risk of poor outcome in patients undergoing cardiopulmonary bypass surgery.

We conducted a prospective, observational study to determine the incidence of feeding intolerance (FI) within 7 d of initiating enteral nutrition (EN) in patients undergoing cardiopulmonary bypass (CPB) and to evaluate the association between FI and a poor prognosis. Patients who underwent CPB surgery at Fujian Medical University Union Hospital between March 2020 and June 2020 were enrolled. According to the presence or absence of FI within 7 d after EN, patients were divided into FI and non-FI groups. According to the occurrence of a poor prognosis (death, gastrointestinal haemorrhage, acute kidney injury, liver insufficiency, neurological events (cerebral infarction, cerebral haemorrhage and epilepsy) and prolonged mechanical ventilation (> 48 h)), patients were divided into poor prognosis and good prognosis groups. The mean age of the 237 CPB patients, including 139 men and ninety-eight women, was 53·80 (sd 12·25) years. The incidence of FI was 64·14 %. Multivariate logistic regression analysis showed factors independently associated with poor prognosis after CPB included FI (OR 2·138; 95 % CI 1·058, 4·320), age (OR 1·033; 95 % CI 1·004, 1·063), New York Heart Association (NYHA) class III/IV cardiac function (OR 2·410; 95 % CI 1·079, 5·383), macrovascular surgery (OR 5·434; 95 % CI 1·704, 17·333) and initial sequential organ failure assessment score (OR 1·243; 95 % CI 1·010, 1·530). Thus, the incidence of FI within 7 d of EN after CPB was high, which was associated with a poor prognosis.