Initiation Of Enteral Feeding Research Articles

Comparative Analysis of Early versus Late Enteral Feeding after Gastrointestinal Surgeries

Background: Despite of widespread belief, clinical studies and animal experiments have suggested that initiation of early feeding after surgery has many advantages. Present study was planned for comparing outcomes of early and late enteral feeding in patients who were undergoing gastrointestinal surgeries in our settings. This would help the surgeons to select better option for earlier recovery after surgery Objective: To compare the outcome of early versus late enteral feeding in patients undergoing gastrointestinal surgeries. Design: It was a randomized controlled trial. Study Settings: The study was conducted at Department of General Surgery, PIMS Islamabad for a period of six months w.e.f 20-12-2017 to 19-06-2018. Patients and Methods: A total of two hundred (n=200) patients of both gender between age 15-70 years, who had been scheduled for elective or emergency gastrointestinal surgery were enrolled in the study. Patients were randomized early (Group A, <24 hours after surgery) and late enteral feeding (Group B, <24 hours after surgery). Outcomes were estimated in terms of infection, anastomotic leak and duration of hospital stay in both groups. Results: Mean age of the patients was 36.8±11.2. There were total 85 females and 115 males with female to male ratio of 1:1.35. Mean duration of hospital stay was 2.62 days ± 0.71 in group A and it was 6.55 days ± 0.71 2.93SD in groups B (P=0.001). Wound infection rate (8% vs 33%, P=0.001) and anastomotic leak rate (0% vs 10%, P=0.001) was also significantly lower in group A when compared with group B. Conclusion: Initiation of early enteral feeding (within 24 hours post operatively) in patients undergoing gastrointestinal surgeries has an immediate advantage of caloric intake and results in faster recovery with fewer complications. Similar results are found in the literature. We recommend early initiation (within 24 hours after surgery) of enteral feeding in patients undergoing gastrointestinal surgeries. Keywords: Anostomotic leak, early enteral nutrition (EEN), late enteral nutrition (LEN).

Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits.

Enteral feeding is the preferred method of nutrient provision for preterm infants. Though parenteral nutrition remains an alternative to provide critical nutrition after preterm delivery, the literature suggests that enteral feeding still confers significant nutritional and non-nutritional benefits. Therefore, the purpose of this narrative review is to summarize health and clinical benefits of early enteral feeding within the first month of life in preterm infants. Likewise, this review also proposes methods to improve enteral delivery in clinical care, including a proposal for decision-making of initiation and advancement of enteral feeding. An extensive literature review assessed enteral studies in preterm infants with subsequent outcomes. The findings support the early initiation and advancement of enteral feeding impact preterm infant health by enhancing micronutrient delivery, promoting intestinal development and maturation, stimulating microbiome development, reducing inflammation, and enhancing brain growth and neurodevelopment. Clinicians must consider these short- and long-term implications when caring for preterm infants.

A new high protein-to-energy enteral formula with a whey protein hydrolysate to achieve protein targets in critically ill patients: a prospective observational tolerability study

ObjectivesCurrent guidelines and expert recommendations stress the need to implement enteral feeds with a higher protein-to-energy ratio to meet protein requirements as recommended while avoiding gastrointestinal side effects and energy overfeeding in ICU patients.Materials and methodsProspective tolerability study in 18 critically ill patients with a high protein formula (high protein-to-energy (HP:E) formula = Fresubin® Intensive; HPG) compared to a contemporary matched conventional therapy group (CTG). The primary outcome was GI intolerance defined as ≥300 ml daily gastric residual volume (GRV), vomiting, or diarrhea on days 1 and 2. Secondary outcomes were the percentage of patients reaching their protein target on day 4 and overall protein intake.ResultsGroups were comparable regarding demographic characteristics, disease severity, organ failures, mechanical ventilation, and NUTRIC score at baseline. Eighteen patients completed the 4-day feeding period. The number of events of GRV of ≥300 ml/day was equal in both groups (33.3%). The incidence of diarrhea and vomiting was low in the HPG (two patients concerned). EN did not need to be discontinued due to intolerance in any group. Seventy-two percent of patients reached protein targets ≥1.3 g/kgBW/d within 4 days after initiation of enteral feeding, which was superior to the CTG (33%). Post-hoc testing showed group differences of protein intake between HPG and CTG were significant at t = 72 h and t = 96 h. Energy targets were met in both groups.ConclusionThe HP:E formula containing 33% whey protein hydrolysate is well tolerated in this tolerability study. Due to the HP:E ratio protein targets can be reached faster. Larger randomized trials are needed to confirm preliminary results.Trial registrationClinicalTrials.gov Identifier: NCT02678325. Registered 2 May 2016.

Ultrasonography-guided post-pyloric feeding tube insertion in medical intensive care unit patients.

In this study, we investigated placement rate, complication rate and time spent of successful post-pyloric enteral feeding (PPEF) tube insertion procedure guided by ultrasonography (USG). The patients who required enteral nutrition and who admitted to medical intensive care unit (MICU) of Gazi University Hospital were included to this single-center, prospective, cohort study. It was aimed to insert the enteral feeding tube into the proximal duodenum as the post-pyloric area by ultrasonography guidance. During the PPEF tube insertion procedure, the linear probe was used to display the proximal esophagus and the convex probe was used to display the post-pyloric area, antrum and pyloric channel. 33 patients were included in this study. The median age was 68 [IQR 52-79] years. There were 17 (51.5%) woman and 22 (66.7%) intubated patients. The enteral feeding tube was successfully passed into the post-pyloric area in 29 (87.9%) patients with this technique. The median time of successful feeding tube insertion was 14 [IQR 10-25] min. The median level of the enteral feeding tube was 74 [IQR 70-76] cm. in successful placement. There was no significant difference in insertion time according to gender (female vs male; 10 [IQR 8-20] min. vs 17 [IQR 12-25] min., p = 0.052) and endotracheal intubation status (intubated vs non-intubated; 14 [IQR 10-25] min. vs 12 [IQR 10-25] min., p = 0.985). Only one complication was seen during study (self-limiting epistaxis in one patient). PPEF tube insertion under USG guidance could ensure the initiation of enteral feeding safely and rapidly without exposure to radiation in ICU patients.

Giant omphalocele: Delayed closure using the San Martin technique following epithelialization of the membrane

AimThe management of patients with congenital anterior abdominal wall defects remains challenging, particularly in cases of giant omphalocele. In 1948, San Martín described a surgical technique for the repair of large midline incisional hernias in adults without the need for a mesh. The purpose of this report is to describe our experience with this technique for the delayed closure of giant omphaloceles. MethodsWe retrospectively reviewed the outcomes of all patients with giant omphalocele managed with the San Martin technique between September 2013 and March 2019. Data collected included birth weight, gestational age, associated malformations, neonatal hospital stay, age at the time of the abdominal wall closure, days on mechanical ventilation (MV) after the closure, time to initiation of enteral feedings, intra- and postoperative complications, and postoperative hospital stay. ResultsA total of 8 patients were included in the study. The median birth weight was 3.190 (2.150 to 3.400) grams. The median gestational age was 35 (32 to 38) weeks. The median age at surgery was 6 (5 to 13) years. The median postoperative days on MV was 3 (3 to 11) days. Enteral feeding were initiated postoperatively at a median of 4 (2 to 4) days. There was one intraoperative complication (minor vascular injury). There were no short-term or long-term complications directly related to the surgical technique. The median postoperative hospital stay was 10 (6 to 16) days. The follow-up was 18 months to 8 years. ConclusionWe believe that the San Martín technique is a valid alternative for the delayed closure of giant omphaloceles. Level of evidenceAccording to the Journal of Pediatric Surgery this research corresponds to type of study level IV for case series with no comparison group.

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

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

Risk Factors for Gastrointestinal Symptoms post Enteral Nutrition Initiation via a Gastrostomy Tube

Background: Percutaneous endoscopic gastrostomy (PEG) facilitates long-term enteral nutrition. However, parenteral nutrition prior to PEG tube placement can cause impaired gastrointestinal function. Additionally, upon initiation of enteral feeding via a PEG tube, some patients suffer from gastrointestinal symptoms (e.g., vomiting, diarrhea), which reduce their quality of life and increase the nursing workload.Method: This retrospective study included 155 patients upon whom the author performed PEG as the attending physician. Enteral nutrition was started through the PEG tube on the third day after its placement. The following characteristics were analyzed: age, gender, indications for PEG, preoperative enteral nutrition, administered liquid nutrients, daily dosage of nutrients, serum albumin levels, serum alanine aminotransferase levels, serum creatinine levels, serum hemoglobin levels, and vomiting or diarrhea within seven days after the initiation of PEG feeding. A logistic regression model was used to identify the risk factors contributing to gastrointestinal symptoms, and three variables were sequentially introduced into the model—preoperative non-enteral nutrition, hypoalbuminemia, and administration of non-elemental diets.Results: Vomiting and diarrhea occurred in 10 and 15 patients, respectively. There were significant differences in administered nutrients and serum albumin levels between patients with and without gastrointestinal symptoms. Multivariate analysis revealed that the adjusted odds ratios for administration of non-elemental diets and serum albumin level ≤3.2 g/dL were 8.05 (95% confidence interval (CI): 2.66–24.4; p 0.001) and 3.81 (95% CI: 1.33–10.9; p 0.05), respectively.Conclusion: The administration of non-elemental diets and a serum albumin level ≤3.2 g/dL were significant risk factors.

Enteral feeding substrate as a risk factor for development of retinopathy of prematurity

Rationale: Mothers own breast milk (MOB) is known to be beneficial as compared to formula when feeding extremely premature infants for prevention of necrotizing enterocolitis and sepsis, and improving developmental outcomes. Earlier initiation of enteral feeding has been reported to decrease risk of retinopathy of prematurity (ROP), but no studies have evaluated both feeding substrate type and timing of enteral feeding initiation. Therefore, we evaluated the association between enteral feeding substrate in early life and ROP.

Safety of Gastrostomy Tube Placement in Patients with Advanced Amyotrophic Lateral Sclerosis With Noninvasive Ventilation.

In patients with amyotrophic lateral sclerosis (ALS), bulbar muscle dysfunction can occur, which eventually requires the initiation of enteral tube feeding. However, there is no consensus on the optimal timing for the gastrostomy or the proper ventilator support method during the procedure. We aimed to investigate the safe range of gastrostomy according to respiratory support status and forced vital capacity (FVC)% of predicted values classification and to compare the safety of noninvasive and invasive mechanical ventilation during the procedure in ALS patients with FVC < 30% of predicted. A total of 477 patients diagnosed with ALS at our institution from January 1, 2009, to December 31, 2018, were evaluated, and 105 patients were enrolled in this study. All medical records covering ventilation status and complications within 6 months to 1 year after the initial gastrostomy were gathered and reviewed. The gastrostomy procedure was considered safe regardless of FVC status or modality of respiratory support. There were complications related to the gastrostomy procedure in 6 of 105 patients and all were managed through conservative care. The incidence of complications, including respiratory ones, for noninvasive and invasive positive pressure ventilation was 5.5% and 9.6%, respectively, which were not statistically significantly different (P = .294). The procedure and tube placement of a gastrostomy can be safely performed in ALS patients with minimal FVC regardless of ventilation invasiveness. We suggest that there should be a new standard for FVC% of predicted to facilitate performing gastrostomy in ALS patients.

Clinical Outcomes of Surgical Treatment of Hypertrophic Pyloric Stenosis &#x0D; with Application of Various Operational Access

Introduction. Treatment options of congenital hypertrophic pyloric stenosis (HPS) appear to be an acute issue nowadays due to the fact that this pathology is often detected in children of the first year of life - according to statistics, the incidence rate of congenital hypertrophic pyloric stenosis in children is 3:1000 live newborns. Since there are various treatment options of the given congenital pathology, there is no general consensus in the opinions of surgeons regarding the superiority of different treatment methods. Therefore, it is necessary to search for a single most relevant treatment technique for this pathology.The aim of the study was to analyze clinical outcomes for treatment of congenital hypertrophic pyloric stenosis in children with application of various surgical techniques: open pylorotomy (transverse, circumbilical incision) and laparoscopic pylorotomy.Materials and methods. The study included 67 patients, who received treatment in Kursk Regional Pediatric Hospital №2 in 2014-2018. Patients with congenital HPS were divided into 3 groups, depending on the performed surgical interventions. Group 1 included patients who underwent an open pylorotomy with transverse access, group 2 included patients who underwent an open pylorotomy with circumbilical access, and group 3 included patients who underwent laparoscopic pylorotomy. The following parameters were used to assess the efficiency of the treatment performed: the duration of the operative intervention, the duration of stay of a child in the ICU, the duration of stay of a child in the hospital, extubation time, initiation of enteral feeding, recovery rate of enteral feeding volume. The data were statistically performed using the Mann-Whitney test to determine the significance of differences between the mean values (p0.05).Results. The study results demonstrated that the shortest duration of operational intervention was observed in patients of group 3, it constituted 41,4 3,5 minutes. In addition, patients of this group spent the shortest average time in the ICU - 4,2 0,3 days - and in the hospital in general - 12,1 0,8 days; initiation of enteral feeding in patients of this group was registered in 10,8 1,2 hours and the recovery rate of enteral feeding volume was 4,8 0,5 days.Conclusions. Having analyzed clinical outcomes for treatment of pilorostenosis in the studied groups of children, it is possible to conclude that laparoscopic pyloromyotomy is preferred to open surgical interventions not only for reasons of cosmetic result, but also according to the criteria of the postoperative course of the disease in patients.

Comparative analysis of enteral feeding practices for prevention of gastrointestinal complications in infants with ductus-dependent congenital heart diseases

Mesenterial hypoperfusion is one of the main pathogenetic factors of necrotizing enterocolitis (NEC) in infants with ductus-dependent congenital heart diseases. NEC in infants undergoing congenital heart surgery increases mortality and length of hospital stay. NEC is also associated with adverse neurodevelopmental outcome. Optimization of enteral feeding can reduce the risk of gastrointestinal complications. NEC risk factors in infants with congenital heart are of special interest in the literature. This article discusses criteria for enteral feeding initiation and increasing preoperatively and after heart surgery. Enteral feeding protocols of leading cardiac surgical centers are reviewed. Practices to provide high energy and nutrient consumption in infants with congenital heart disease are described.

Intestinal Colonization Rate of Candida albicans among Low Birth Weight Neonates after Using Oral Synbiotic Supplementation: A Randomized Placebo-controlled Trial

Background: The present study aimed to evaluate the effect of synbiotics on the intestinal colonization rate of Candida albicans in low birth weight neonates (i.e., under 2,500 g), which is one of the most important events for necrotizing enterocolitis (NEC).Methods: During one year, 106 preterm neonates with a birth weight of less than 2,500 g, admitted to the Neonatal Intensive Care Unit (NICU) of Imam Reza Hospital, affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran, were randomly selected and investigated in two groups of case and control. In the case group, 5 drops of synbiotics (under the trade name of Pedilact in which 5 drops are equivalent to 2.5×108 CFU), containing three probiotics of Bifidobacterium infantis, Lactobacillus rhamnosus, and Lactobacillus reuteri, as well as the prebiotic of fructooligosaccharide, were administered. On the other hand, 5 drops of distilled water were used for the control group. In the present single-blind study, the subjects were divided into two groups using a random number table. The stool cultures were obtained on the 1st and 10th days of admission. Then, the two groups were compared in terms of the amount of positive stool culture for Candida albicans, time of feeding initiation and full nutrition, duration of hospitalization, and time of discharge.Results: The incidence rate of positive stool culture for Candida albicans was 6.6%. A significant relationship was observed between gestational age and positive culture (P=0.009). However, there was no significant difference between the two groups in terms of the duration of hospitalization, time of feeding initiation and full feeding, good physical examination results, and wellbeing. In addition, the relationship between positive culture and birth weight was statistically significant (P=0.045) since the rates of positive culture were 57.1% and 42.9% in cases with the birth weight of ≤ 1,500 and > 1,500 g, respectively.Conclusion: Based on the results, synbiotic use showed no significant relationship with enteral positive cultures for Candida albicans, time of enteral feeding initiation and full feeding, and hospitalization duration.

Hyperglycemia in Extremely Preterm Infants.

Hyperglycemia after birth is common in extremely preterm infants (<28 weeks of gestation). Lower gestational age, lower birthweight, presence of severe illness, and higher parenteral glucose intake increase the risk for hyperglycemia, while provision of higher amounts of amino acids and lipids in parenteral nutrition and early initiation and faster achievement of full enteral feeding decrease the risk. Hyperglycemia is associated with increased mortality and morbidity in the neonatal period. Limited data show an association with long-term adverse effects on growth, neurodevelopment, and cardiovascular and metabolic health. Lowering the glucose infusion rate and administration of insulin are the 2 treatment options. Lowering the glucose infusion could lead to calorie deficits and long-term adverse effects on growth and neurodevelopment. Conversely, insulin use increases the risk for hypoglycemia and requires close blood glucose monitoring and frequent adjustments to glucose infusion and insulin dosage. Randomized trials of varying strategies of nutrient provision and/or insulin therapy and long-term follow-up are needed to improve clinical care and overall health of extremely preterm infants with hyperglycemia.

Elevated Coefficient of Variation in Total Fecal Bile Acids Precedes Diagnosis of Necrotizing Enterocolitis

Accumulation of bile acids (BAs) may mediate development of necrotizing enterocolitis (NEC). Serial fecal samples were collected from premature infants with birth weight (BW) ≤ 1800 g, estimated gestational age (EGA) ≤ 32 weeks, and <30 days old prior to initiation of enteral feeding. Nine infants that developed Bell’s Stage ≥ II NEC were matched with control infants based on BW, EGA, day of life (DOL) enteral feeding was initiated and DOL of the first sample. From each subject, five samples matched by DOL collected were analyzed for BA levels and composition. Fifteen individual BA species were measured via LC-MS/MS and total BA levels were measured using the Diazyme Total Bile Acid Assay kit. No statistically significant differences in composition were observed between control and NEC at the level of individual species (p = 0.1133) or grouped BAs (p = 0.0742). However, there was a statistically significant difference (p = 0.000012) in the mean coefficient of variation (CV) between the two groups with infants developing NEC having more than four-fold higher mean CV than controls. Importantly, these variations occurred prior to NEC diagnosis. These data suggest fluctuations in total fecal BA levels could provide the basis for the first predictive clinical test for NEC.

The 2-Minute Spontaneous Swallowing Screening Predicts Independence on Enteral Feeding in Patients with Acute Stroke

BackgroundIt is recommended that enteral feeding should be offered to patients with dysphagia estimated to be unable to take adequate diet orally within 7 days of admission after acute stroke, but there is no clear criterion for initiation of enteral feeding. Recent studies have reported that the frequency of spontaneous swallowing is useful in screening for dysphagia in acute stroke. The present study was aimed to investigate whether measurement of frequency of spontaneous swallowing for 2 minutes could predict independence on enteral feeding 1 week after admission in patients with acute stroke. MethodsPatients with acute stroke were subjected. Within 72 hours of stroke onset, the number of swallows for 2 minutes was measured by auscultation. Subsequently, 1-hour frequency of spontaneous swallowing was measured using a laryngeal microphone. Functional Oral Intake Scale (FOIS) was evaluated 1 week after admission. ResultsTwenty-six out of 40 patients were independent on enteral feeding 1 week after admission based on FOIS. The presence of spontaneous swallowing for 2 minutes had .89 sensitivity, .54 specificity to predict independence on enteral feeding 1 week after admission, whereas the 1-hour frequency of spontaneous swallowing had 1.00 sensitivity, .46 specificity. Logistic regression analysis demonstrated that the presence of spontaneous swallowing for 2 minutes was independent predictor for independence on enteral feeding 1 week after admission, independently of age, sex, and NIHSS. ConclusionsThe 2-minute spontaneous swallowing screening predicts independence on enteral feeding 1 week after admission in patients with acute stroke.

Abstract 211: Enteral Feeding Shortly After Cardiac Arrest Treated With Veno-Arterial Extra Corporeal Membrane Oxygenation and Therapeutic Hypothermia is Safe and Feasible

Introduction: Literature regarding the timing and safety of enteral feeding after cardiac arrest treated with therapeutic hypothermia and veno-arterial extra corporeal membrane oxygenation (VA-ECMO) is lacking. Aim: To describe the safety and feasibility of early enteral feeding in adult patients presenting with refractory out-of-hospital cardiac arrest treated with VA ECMO and therapeutic hypothermia. Methods: We performed a retrospective analysis of the enteral feeding patterns for patients admitted through the University of Minnesota ECPR program for refractory ventricular tachycardia or fibrillation (VT/VF). Outcomes were compared in patients with early enteral feeding initiation (within 2 days of admission) versus those with delayed enteral feeding (&gt;2 days after admission). Results: The study included 108 consecutive patients (age 56.3+/-12.2 years, 78% male) admitted to the CICU between December 2015 and February 2019. Average CPR duration was 62.8+/-15.3min. Enteral feeding was initiated in 68(62.9%) of the sample. Enteral feeding was not started in patients expected to die within 48 hours of ICU admission. All patients underwent therapeutic hypothermia and 97.2% received neuromuscular blockade. Time to enteral feeding initiation ranged from 1 to 11 days post admission. Patients who had enteral feeding started within the first two days (43%) had similar rates of feeding interruption, (with 40% of cases in the setting of a surgical procedure or family request), gut ischemia, ileus and ventilator associated pneumonia (Table 1). Mortality and neurologic outcomes were not affected by timing of enteral feeding initiation. Conclusion: Initiation of enteral feeding within the first two days of presentation was not associated with adverse outcomes in patients with refractory cardiac arrest treated with prolonged CPR, VA ECMO, and therapeutic hypothermia.

Historical Perspectives: Low Birthweight and Preterm Infants in Indonesia.

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

THE USE OF HIGH FLOW NASAL CANNULA (HFNC) IN CHILDREN WITH BRONCHIOLITIS AND TIMING OF SAFE ENTERAL FEEDING IN A PEDIATRIC IN PATIENT UNIT: A RETROSPECTIVE REVIEW

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: The use of HFNC as non- invasive respiratory support in children with bronchiolitis has increased over the last several years. Several studies have investigated enteral feeding safety while on HFNC. This study investigates the safety of oral feeding prior to and following implementation of a HFNC feeding protocol. The purpose is to 1) Investigate safety of feeding in children with bronchiolitis on HFNC, 2) timing of enteral feeding initiation and quantify the HFNC flow for safe feeding. METHODS: A retrospective observational cohort study in children ≤2 years of age with bronchiolitis, requiring HFNC, from September, 2017 to January 15, 2019. Feeding complications were defined as increased work of breathing within one hour at start of feeding, vomiting, increased HFNC settings. Safety of enteral feeding was defined as absence of feeding complications. We recorded the timing of enteral feeding from the initiation of HFNC, duration of enteral feeding while on HFNC, and the flow of HFNC at which the feeding was initiated. We compare the data prior and post implementation of a HFNC feeding protocol. RESULTS: Descriptive statistics were calculated separately by pre and post protocol implementation. Comparison of two groups using the chi-square test for categorical variables and Mann-Whitney for continuous data and statistical significance at p<0.05 level. Analyses were performed using SAS version 9.4 (SAS Institute Inc. Cary, NC). Patients in both, pre- and post-protocol implementation groups have no feeding complications on HFNC. Subjects in Post (n=30) vs. Pre-Protocol Implementation (n=36) had a higher median amount of liters flow when initiating enteral feeding (8.0 vs. 6.0 respectively, p<0.024) and prolonged days on HFNC (4.0 vs. 3.0, p<0.030). Post-protocol implementation, enteral feeding was initiated sooner (days NPO 1.0 vs 2.0). No other significant differences between the two cohorts with respect to other variables were observed. (Table 1). CONCLUSIONS: Our data supports that enteral feeding in patients with bronchiolitis on HFNC is safe. Standardization due to current protocol, allowed safe earlier feeding of children on HFNC, reducing the time spent NPO. CLINICAL IMPLICATIONS: The use of HFNC offers an innovative alternative to traditional oxygen delivery and allows safe enteral feeding under the current bronchiolitis protocol at our institution. DISCLOSURES: No relevant relationships by Meredith Akerman, source=Web Response No relevant relationships by Arsenia Asuncion, source=Web Response No relevant relationships by Thomas Conway, source=Web Response My spouse/partner as a Employee relationship with Siement Healthiniers Please note: >$100000 Added 03/15/2019 by Claudia Halaby, source=Web Response, value=Salary

Breastfeeding promotion strategies study on preterm infants in the neonatal intensive care unit

To explore the effect of breastfeeding promotion strategies on neonatal clinical outcomes of preterm infants during hospitalization in the neonatal intensive care unit (NICU). We developed breastfeeding promotion strategies, including the establishment of a multidisciplinary breastfeeding steering team, breastfeeding support of families and society, family-integrated care, kangaroo mother care, donor human milk bank, and so on. Preterm infants meeting the inclusion standard, less than 32 weeks gestational age, who were admitted to NICU from November 2015 to February 2017 were enrolled, and the eligible infants were divided into two groups (control group and intervention group) before and after policy implementation. The data of preterm infants including breastfeeding related outcomes (time to initiation of enteral feeding, time to initiation of breastfeeding, time to achieve full breastfeeding, time to achieve full enteral feeding and rate of breastfeeding), growth (extrauterine growth restriction) and complications were compared between the two groups. One hundred and twenty-three preterm infants were enrolled, including 61 in the control group and 62 in the intervention group. There were no significant differences in gender, gestational age, birth weight, intrauterine growth retardation (IUGR) and admission disease status between the two groups (P>0.05). Compared with the control group, there were significantly earlier time to initiation of enteral feeding [15.37 (10.00, 22.13) h vs. 20.25 (12.88, 26.33) h, P<0.01], time to achieve full breastfeeding [91.00 (69.75, 103.00) h vs. 94.00 (80.37, 118.75) h, P=0.04], and time to achieve full enteral feeding [12 (11, 15) d vs. 14 (12, 18) d, P<0.01] in the intervention group. Otherwise, there were no significant differences in time to initiation of breastfeeding, hospital stay, extrauterine growth restriction (EUGR) occurance rate of weight, the rate of breastfeeding, motality, and the incidence of complications including feeding intolerance, neonatal necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) (P>0.05). The breastfeeding promotion strategie was a quality improvement of ordinary breastfeeding protocol. It had significantly reduced time to initiation of enteral feeding, time to achieve full breastfeeding and time to achieve full enteral feeding for preterm infants in NICU. Further research is needed to confirm whether the strategies can improve the breastfeeding rate and reduce the occurrence of the complications, such as NEC, BPD, and ROP.

Interventions for Feeding and Swallowing Disorders in Adults with Intellectual Disability: A Systematic Review of the Evidence.

Feeding and swallowing disorders are prevalent in adults with Intellectual Disability (ID) and can potentially lead to discomfort, malnutrition, dehydration, aspiration, and choking. Most common interventions include: diet modification, compensatory strategies, swallowing therapy, and non-oral feeding. Despite their common use, the research evidence for these interventions is lacking. The current study aimed to systematically review the evidence for the safety and the effectiveness of interventions for feeding and swallowing disorders in adults with ID. Seven electronic databases, conference proceedings, and reference lists of relevant studies were reviewed from online availability to March 2019, with no language restrictions. Eligibility criteria encompassed experimental or non-experimental study design, adults (> 18 years) with ID and feeding and/or swallowing disorders (any etiology and severity) and any intervention for feeding and/or swallowing disorders. Methodological quality was assessed by two independent reviewers using the Downs and Black checklist. Four articles met the inclusion criteria. All included studies considered enteral feeding as an intervention strategy and had a retrospective observational design. Overall, included studies reported positive change in nutritional status and a high incidence of adverse events following enteral feeding initiation. Risk of bias was high with variability in methodological quality. The safety and effectiveness of interventions for feeding and swallowing in adults with ID is unclear. This review highlights the lack of evidence-based practice in this area. Directions for further research are provided. Before enteral feeding initiation, risks and benefits should be appropriately balanced on an individual basis, and caregivers should be involved in the decision-making process.