Late Enteral Feeding Research Articles

Comparing the microbiological characteristics of early vs late enteral feeding tube exit site infection

Comparing the microbiological characteristics of early vs late enteral feeding tube exit site infection

Enteral feeding in neonates ≥34 weeks of gestation with moderate to severe birth asphyxia: A retrospective observational study.

There are no standard guidelines regarding time for initiation of feeds in moderate to severely asphyxiated neonates and data regarding the same in neonates are scanty. Case sheets of all neonates born ≥34 weeks of gestation who satisfied the definition were analysed. The early feeding group was defined as those in whomh feeds were started <24 h and the late feeding group as those started ≥24 h of life. The primary outcome of the study was time to achieve full enteral feeds. A total of 184 neonates were enrolled. Mean time to reach full enteral feeding was 53.7 ± 24.8 h in the early feeding group as compared to 95.0 ± 81.1 h in late enteral feeding group, with a mean difference of 41.3 (25.7-56.8) h. The incidence of adverse secondary outcomes was higher in the late feeding group.

The Impact of Early Nutrition Following Peroral Endoscopic Myotomy in Achalasia: A Tertiary Center Experience.

This retrospective single-center study aimed to assess the safety of early feeding in patients who met certain criteria following peroral endoscopic myotomy (POEM). Data from 100 patients who underwent POEM at our center between January and December 2022 were collected. Early feeding was defined as the introduction of clear liquid foods at 4 hours post procedure. At 4 and 24 hours, the pain was rated using the visual analog scale (VAS) in all patients. Patients without intraoperative complications (pneumoperitoneum requiring needle drainage, severe arterial bleeding requiring the use of hemostatic forceps, severe mucosal injury) and severe pain (VAS score > 6) and nausea-vomiting at the fourth postoperative hour were given the early feeding approach. In patients who did not meet these requirements, enteral feeding was initiated after 24 hours (late feeding). Among the 100 patients, 50 patients were categorized early feeding. No patients had a control esophagogram. In the early and late enteral feeding groups, VAS scores were 4 (0-6) and 6 (1-8) (P< 001) at 4 hours and 1 (0-3) and 1 (0-6) (P = .043) at 24 hours, respectively. No severe complications were developed after early feeding. The median hospital stay in the early feeding group was 1 (1-3) day. There was no emergency readmission in any of early feeding patients. Our study showed early feeding following POEM can be begun in achalasia patients who do not have intraoperative complications, severe pain, or nausea/vomiting.

Evaluating early versus late (traditional) enteral feeding on nutritional status in a surgical intensive care unit patients (SICU)

Evaluating early versus late (traditional) enteral feeding on nutritional status in a surgical intensive care unit patients (SICU)

Risk Factors Affecting Length of Stay in Preterm Infants at Wangaya Regional General Hospital, Indonesia

Background: Advances in neonatology have led to many preterm infants being saved. Prolonged length of stay (LOS) increases the incidence of neonatal complications and even mortality, placing a significant economic burden on families and strain on healthcare systems. This study aims to determine the factors associated with LOS in preterm infants.&#x0D; Methods: This cross-sectional study involved 60 preterm babies treated at Wangaya Hospital from May 2022 to May 2023. Infants with congenital anomalies, referred from other hospitals and did not receive appropriate treatment were excluded from the study. Data were taken from the electronic medical record after obtaining ethical clearance and then analyzed using descriptive statistics and linear regression in SPSS 25. Statistical significance was considered at 0.05.&#x0D; Results: As many as 46 out of 60 preterm infants were born at moderate to late preterm gestational age. The majority of 81.7% of infants were born with a body weight of 1500-2499 grams. The median number of LOS was 7.5 days (IQR 15). Multivariate analysis of numerical independent variables obtained an equation log [LOS] = 2.902-0.066*gestational age+ 0.022*duration of parenteral nutrition (R2 = 78.1%). Meanwhile, in the categorical independent variables obtained, an equation log [LOS] = 0.398 + 0.223*very preterm + 0.144* RDS + 0.178*NEC + 0.206*prolonged antibiotics administration + 0.278*late enteral feeding + 0.148*abdominal distension + 0.144*vomiting (R2 = 87.4%).&#x0D; Conclusion: Factors influencing LOS of preterm infants are gestational age, duration of parenteral nutrition, the presence of RDS, NEC, vomiting, abdominal distension, late enteral feeding, and prolonged use of antibiotics. It is essential to carry out antenatal care for pregnant women to prevent premature birth.

Early Versus Late Feeding After Percutaneous Endoscopic Gastrostomy Placement in Trauma and Burn

IntroductionTiming to resume feeds after percutaneous endoscopic gastrostomy (PEG) placement continues to vary among US trauma surgeons. The purpose of this study was to assess differences in meeting nutritional therapy goals and adverse outcomes with early versus late enteral feeding after PEG placement. MethodsThis retrospective review included 364 trauma and burn patients who underwent PEG placement. Data included patient characteristics, time to initiate feeds, rate feeds were resumed, % feed volume goals on postoperative days 0-7, and complications. Statistical analysis was performed comparing two groups (feeds ≤ 6 h versus > 6 h) and three subgroups (< 4 h, 4-6 h, ≥ 6 h) based on data quartiles. Chi-square/Fisher’s exact test, independent-samples t-test, and one-way analysis of variance were used to analyze the data. ResultsMean time to initiate feeds after PEG was 5.48 ± 4.79 h. Burn patients received early feeds in a larger proportion. A larger proportion of trauma patients received late feeds. The mean % of goal feed volume met on postoperative day 0 was higher in the early feeding group versus the late (P < 0.001). There were no differences in adverse events, even after subgroup analysis of those who received feeds < 4 h after PEG placement. ConclusionsPatients with early initiation of feeds after PEG placement achieve a higher percentage of goals on day 0 without an increased rate of adverse events. Unfortunately, patients routinely fall short of their target tube feeding goals.

Comparative study between early versus late enteral nutrition after gastrointestinal anastomosis operations

Introduction An anastomosis of the digestive tract is a common operation, whether it be an unexpected medical crisis or a planned procedure. Feeding soon after gastrointestinal anastomosis is not only physiological, but also protects against morphologic and functional trauma-related modifications in the gut. Aim of work This research aimed to evaluate the advantages and disadvantages of initiating Enteral Nutrition immediately following gastrointestinal anastomosis surgery versus delaying it for a later time. Additionally, the frequency of Adverse Events. Patients and methods Thirty patients underwent abdominal surgery, with treatments ranging from small- to large-intestine anastomosis, for both urgent and elective reasons. Early postoperative enteral feeding in the early feeding group commenced within 24 h of surgery or immediately following nasogastric tube removal. The delayed feeding group began enteral feeding using the standard technique once bowel sounds were restored, distention was gone, and the patient passed flatus or stool. 14 patients were in the early enteral feeding group (A) while 16 patients were in the late enteral feeding group (B). Data regarding blood loss and transfusion, NGT removal time, time of intestinal sounds return, time of passage flatus and stool, hospital stay and postoperative complications were recorded. Results Among those who ate too early (46.6%), those who ate late (53.3%), abdominal distension was noted in 28.6%,in the early group and 43.8% in late feeding group and vomiting was reported in 50.0%, and 62.5%, respectively. In the first group, 57.1% of those who fed early experienced fever, while in the second group, 75.0% of those who fed late did so. Late feeding is associated with a statistically significant rise in both the Day of NGT removal and the Length of stay. When patients were admitted for early feeding, they stayed in the hospital for an average of 5.71 days. There was no statistically significant difference according serum albumin between the early feeding (3.79) and late feeding (3.50). There was a significantly higher concentration of potassium in the blood in the early feeding group (3.93) compared to the late feeding group (3.219). Anastomotic leaking, surgical site infection, and intensive care unit admission were not significantly different between early and late feeding. Conclusion Early enteral feeding has the upper hand on late enteral feeding as it goes with GIT physiology, we found that early postoperative feeding following gastrointestinal anastomosis surgery significantly reduced the day of NGT removal and the length of hospitalization, which may be attributable to fewer problems and better gut motility and healing.

Early versus Late Enteral Feeding in Preterm Intrauterine Growth Restricted Neonates with Antenatal Doppler Abnormalities

Background: Placental insufficiency and decreased placental nutrition transfer from the mother to the fetus are the underlying causes of intra-uterine growth restriction (IUGR), a serious and very frequent issue in the perinatal period. Due to a lack of recent research in the area, the current study aims to compare the outcomes of two different feeding strategies for preterm infants with abnormal Doppler readings: early vs. delayed initiation of enteral feeds. Then we implement the better of the two feedings regimens into our standard clinical practice. Objective: The objective of the study was to compare early and late enteral feeding in preterm intrauterine growth restricted neonate to evaluate time to reach full feed, risk of feed Intolerance, weight gain at 10th day of life and length of hospital stays. Study Design: The Randomized Control Trial. Settings: This study was conducted in the neonatology department Tertiary Care Hospital (Nursery MCH Centre, Pakistan Institute of Medical Sciences, Islamabad Pakistan. Duration: 1st June 2022 to 1st December 2022. Methods: The sample was collected from the by non-probability consecutive sampling technique. Babies of any sex who meet the requirements during the first 72 hours of life. A total of 80 newborns were recruited out of them n=40 infants were found as early feeding and n=40 was assigned to late feeding. Demographic and baseline information (admission date, age, gender, gestational age, birth weight) of enrolled neonates recorded in the prescribed proforma. Effects of early or late feeding were monitored daily for 10 days. The outcomes in terms of time to reach full feed, weight gain at 10th day of life and feed intolerance were recorded and compared in both groups. All the information entered on the predesigned proforma by the researcher himself to comply with the study protocol attached. Results: A total of 80 newborns were recruited out of them n=40 infants were found as early feeding and n=40 was assigned to late feeding. The base line characteristics including birth weight, gestational age, respiratory support etc. were not statistically significant. Also, there is no difference of NEC (0.267) and FI (0.312) in early and late feeding groups. The Cox regression HR: 1.21 (95% CI: 0.829-3.72); p = 0.326). In both groups, the early feeding arm had a shorter median duration by 7 days. Further, the data was compared between early and late feeding group to determined which group is quicker for discontinuation of PN. Conclusion: Our study finds that using the feeding initiation and advancement method and AREDF on Doppler with exclusive breast milk results in faster PN cessation and does not increase the incidence of NEC or FI in preterm IUGR infants between 27 and 33 weeks of age.

Benefits of Early Implementation of Enteral Feeding in Ventilated COVID-19 Patients: A Systematic Review of Current Literature

Introduction: COVID-19 (SARS-CoV-2) has swept destruction across the world and continues to cause significant morbidity and mortality. For critically ill patients requiring mechanical ventilation enteral feeding is typically required for nutritional support. Method: Due to the novelty of this virus, protocols have been aimed to mimic Acute Respiratory Distress Syndrome (ARDS) patient nutritional support. There is limited data around the benefits of early enteral nutritional support for mechanically ventilated patients. Result: Data from two studies evaluated the use of enteral nutrition protocols in critically ill COVID-19 patients and revealed only minor significant differences in hospital course between early and late enteral feeding. There were better outcomes overall for COVID-19 patients who were able to tolerate enteral feeding compared to patients who were intolerant of enteral feeding. Conclusion: Future studies involving a baseline nutritional assessment may help clinicians better understand the role of early enteral nutrition support among mechanically ventilated COVID-19 patients.

High risk of complications and mortality in cirrhotic patients with acute pancreatitis

High risk of complications and mortality in cirrhotic patients with acute pancreatitis

Comparison of Stay in a Hospital in Early Versus Late Enteral Feeding

Comparison of Stay in a Hospital in Early Versus Late Enteral Feeding

Early enteral feeding in patients with gastrointestinal surgery time to send the patient home early

Background: There has been a trend among surgeons to delay enteral feeding following gastrointestinal surgery so that complications like anastomotic site leak and infection can be prevented and also to give time for operated site to heal. Newer studies suggest that early enteral feeding is useful in comparison to conventional method of feeding i.e. waiting for bowel function to return. This study was undertaken to evaluate the safety and tolerability of early enteral feeding after gastrointestinal surgeries in terms of postoperative complications and length of hospitalization.Methods: This study was prospective observational study with retrospective controls done over a period of 18 months at a tertiary care center in India. 35 patients were included in each group (case versus control). Early enteral feeding was defined as commencement of oral feed within 48 hours of surgery. The data was analyzed using statistical package of social science (SPSS Version 20; Chicago Inc., USA).Results: Both groups were found to be well matched in terms of age and sex distribution. The mean hospital stay for patients given early enteral feeding was significantly lower as compared to controls (10.26±3.09 versus 13.4±2.186). They had a complication rate of 11.4 % as compared to late enteral feeding group (25.7%).Conclusions: Early enteral feeding has been found beneficial in most of the studies worldwide. Hence, it is time to open our minds and embrace it to improve surgical outcome in gastrointestinal surgery practice.

Effect of Early versus Late Enteral feeding on the outcome of Mechanically Ventilated Patients in intensive care units

Effect of Early versus Late Enteral feeding on the outcome of Mechanically Ventilated Patients in intensive care units

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, &lt;24 hours after surgery) and late enteral feeding (Group B, &lt;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).

Comparison of early versus late enteral feeding following gut anastomosis.

Objectives: To compare early feeding versus late enteral feeding following gut anastomosis in term of hospital stay. Study Design: Prospective Randomized Control study. Setting: Surgical Unit 1, Holy Family Hospital, Rawalpindi. Period: April to October 2017. Material &amp; Methods: All patients, excluding paediatric age group (n= 60) undergoing emergency or non-emergency gut resection with primary anastomosis were incorporated. Two strata were devised. Group A (n=30) received early enteral feeding starting at 12th post-operative hours in form of 100-150ml fluid thrice daily. Group B endured being Nil per oral for 72hrs. Both groups were correlated for timing of return of bowel sounds and timespan of hospital stay. P value &lt; 0.05 was considered noteworthy. Results: Overall 60 patients with 30 in each group were incorporated. They were predominantly males (55%) and belonged to middle age group (Group A=31.73+10.78 years; Group B= 36.00+10.53 years). Mean time for return of bowel sounds in both the groups was 24.40+5.88 hours and 35.20+10.88 hours respectively, which was striking (p value &lt;0.05). Mean length of hospital stay in both the groups was also noteworthy i.e. 5.23+0.72 days and 6.40+1.67 days respectively. Conclusion: In the wake of gut anastomosis, early oral feeding at 12hours is superior to delayed oral feeding after 72hours, in terms of mean time for return of bowel sounds and period of hospital stay.

Comparative study of early vs late enteral feeding following intestinal anastomosis

Comparative study of early vs late enteral feeding following intestinal anastomosis

A comparative study between early enteral feeding and late enteral feeding following gastrointestinal surgery

A comparative study between early enteral feeding and late enteral feeding following gastrointestinal surgery

The Effect of Enteral Tube Feeding on Patients' Health-Related Quality of Life: A Systematic Review.

Patients with functional gastrointestinal tract who are unable to meet their nutritional requirements may benefit from the use of enteral nutrition via feeding tubes which could be nasogastric, percutaneous endoscopic gastrostomy and jejunostomy. Although enteral tube feeding has been shown to promote nutritional status, improve wound healing, and enhance patients’ quality of life (QoL), evidence of tube and feed complications and reduced QoL has also been reported. Despite the increasing prevalence of patients on enteral tube feeding, no systematic review examining the role of enteral tube feeding on patients’ QoL appears to have been published. Aim: The aim of this systematic review is to evaluate the effect of enteral tube feeding on patients’ QoL. Method: Three databases (EMBASE, Pubmed, and PsycINFO) plus Google Scholar were searched for relevant articles based on the Population, Intervention, Comparator, Outcomes (PICO) framework. The review was in line with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and involved the use of synonyms and medical subject headings. In addition, search terms were combined using Boolean operators (AND/OR) and all the articles retrieved were exported to EndNote for de-duplication. Results: Fourteen articles which met the criteria were included and three distinct areas were identified: the effect of early versus late enteral tube feeding on QoL; the QoL of patients on gastrostomy versus standard care, and the effect of enteral tube feeding on QoL. Overall, nine studies reported improvement in the QoL of patients on enteral tube feeding, while five studies demonstrated either no significant difference or reduction in QoL. Some factors which may have influenced these outcomes are differences in types of gastrostomy tubes, enteral feeding methods (including time patients spent connected to enteral feed/pump), and patients’ medical conditions, as well as the generic and/or type of QoL measuring instrument used. Conclusion: Most reviewed studies suggest that enteral tube feeding is effective in improving patients’ QoL. The use of enteral tube feeding-specific QoL measuring instruments is recommended for future research, and improved management strategies including use of mobile enteral feeding pumps should further enhance patients’ QoL. More studies on the effect of delivery systems/enteral feeding pumps on QoL are needed as research in this area is limited.

Assessment of gastrointestinal dysfunction in selection of an effective method of nutritional support in patients with acute pancreatitis.

Potential mortality in acute pancreatitis (AP) is 5%. Patients with AP represent II type of intestinal insufficiency, which occurs on the background of dyspeptic syndrome and increased intra-abdominal pressure (IAP). IAP is a differentiated indicator. With the increase of IAP more than 10 mmHg, intra-abdominal hypertension (IAH) arises. Increasing IAP to this level is considered as safe. Monitoring of IAP level allows to achieve better clinical results. Totally 47 patients with acute pancreatitis were examined. Depending on the function of the gastrointestinal tract and the selected type of starting nutritional support (NS), they were divided into 2 groups. The first group consisted of IAH patients of I degree and dyspeptic syndrome who underwent parenteral nutrition (PN) with 3-component compounds begun on the 2nd day of disease and after restoration of gastrointestinal tract function a late enteral feeding (LEF) was performed. In the second group, patients with AP were initially diagnosed with elevated IAP at a safe level and dyspeptic syndrome. They were prescribed early enteral nutrition (EEN) with specialized blends from the 2nd day of disease. In 2 days a significant reduction in pain syndrome with the persistence of dyspeptic syndrome and intestinal insufficiency (II) was recorded. In patients with intra-abdominal hypertension, total parenteral nutrition is the effective method of nutritional support, against which, after 5 days manifestations of dyspeptic syndrome and IAP indices decrease to a safe level. Therefore in-time detection of high level of intra-abdominal pressure in patients with acute pancreatitis can help to choose a more rational method of nutritional support.

Early versus delayed enteral feeding in acute pancreatitis

Background: Early enteral feeding through a nasoenteric feeding tube is often used in patients with acute pancreatitis, as compared to previous notion of pancreatic rest. This study aims to compare various outcomes of early and late enteral feeding in severe acute pancreatitis.Methods: This study was a randomized trial conducted at Victoria hospital, Bengaluru between July 2016 and June 2017. Patients with severe acute pancreatitis were randomized into early enteral feeding and late enteral feeding groups in the ratio of 1:1. Early enteral feeding group were started on oral feeds within 24 hours of admission. Late enteral feeding group were started on oral feeds after 72 hours of admission. Patient demographics, clinical findings, investigations, length of hospital stay, complications were assessed and compared.Results: In 124 out of 132 patients were included who met inclusion criteria. The mean age of patients was 28.6 years. There were 120 males (96.7%) and 4 females (3.2%). There were no significant differences in age, sex ratio and comorbidities between the two groups. Early enteral feeds group showed lesser number of gastrointestinal adverse effects after initiation of enteral feeds, lesser number of days taken to develop full tolerance to enteral feeds, lesser number of days of admission, lesser complications like necrotizing pancreatitis, single or multiple organs failure, lesser number of ICU admissions, requiring mechanical ventilation, including lesser mortality when compared to delayed enteral feeds group.Conclusions: Patients with severe acute pancreatitis can safely be started on early enteral feeds within 24 hours of admission.