Nasogastric Drip Research Articles

Nasogastric Drip Rehydration Therapy in Acute Diarrhea with Severe Dehydration

WHO recommended severe dehydration without shock in acute diarrhea to be rehydrated by nasogastric drips (NGD) of oral rehydration solution (oralit). In this respect the criteria of a still palpable and countable pulse, the absence of meteorism and absence of complication, the reverse warranting iv fluid therapy, can be used as practical guidelines to identify the patient "without shock".
 A clinical trial comparing the result of NGD oralit rehydration therapy to that of intravenous Ringer-lactate on small children with diarrhea and severe dehydration was conducted. Seventy jive patients admitted to the Department of Child Health Palembang General Hospital from January up to July 1986, aged 1 to 59 months, suffering from acute diarrhea with severe dehydration fulfilled to above mentioned criteria. Randomly 36 were assigned to NGD rehydration therapy using WHO standard ORS (in Indonesia is named as oralit) and 39 were rehydrated with iv Ringer lactate solution, given in four hours consisting of 40ml/kg BW, 30ml/kg BW, 20 ml/kg BW and 20ml/kg BW in the first, second, third and fourth hours respectively.
 Based on the failure rate of rehydration in the first four hours, the recurrence of dehydration after rehydration and the side effects of fluid therapy, it was concluded that acute diarrhea cases with severe dehydration who fulfilled the above mentioned criteria can be rehydrated by NGD oralit as effective and safe as by iv Ringer lactate.

A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome

To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants. All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005. Nationwide 158 cases reported, correspond to an incidence of 58/y/100,000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100,000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11-25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge. The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose.

Treatment of the acute crisis in maple syrup urine disease.

The acute crisis of metabolic decompensation in maple syrup urine disease is a potentially lethal medical emergency that requires reduction in concentrations of leucine and other branched-chain amino acids in plasma. Experience with intravenous mixtures of amino acids indicates that this can be accomplished by the synthetic forces of protein synthesis. However, these intravenous mixtures are not generally available. To develop enteral mixtures suitable for administration by nasogastric drip in minimal volume. Mixtures of amino acids were designed containing no leucine, isoleucine, or valine for administration by nasogastric drip. Needs for water and calories were to be met intravenously. They were designed to be used in the management of the acute crisis. Inpatient pediatric service. Two patients with maple syrup urine disease. Data were collected during the management of 3 episodes of metabolic imbalance. Studies were carried out for 4 to 11 days, during which there was no intake of leucine. Four different mixtures were used and a fifth was designed on the basis of this experience. Effects on the concentrations of leucine and the other branched-chain amino acids. Clinical status closely mirrored the concentration of leucine. In each instance, a progressive fall in leucine concentration was obtained. Rates of fall were comparable to those obtained with intravenous therapy. Concentrations of isoleucine fell to levels that made this amino acid limiting for protein synthesis and hence therapeutic effect. This led to greater and earlier supplementation with isoleucine. Valine supplementation was also useful. The acute crisis of metabolic imbalance in maple syrup urine disease may be effectively treated by the continuous intragastric drip of solutions of amino acids devoid of leucine along with provision of water and calories intravenously.

231 EFFECTS OF EARLY POSTNATAL RECOMBINANT HUMAN GROWTH HORMONE (rhGH) TREATMENT ON PROTEIN METABOLISM IN INTRA UTERINE GROWTH RETARDED (IUGR) PRETERM INFANTS: a pilot study

Treatment with rhGH has direct anabolic effects in catabolic adult intensive care patients. Preceding a randomised double blind placebo controlled investigation, a pilot study was performed in 10 type II (non-symmetric) IUGR preterm infants (birthw. 920 ± 155 g., gest. age 30 ± 2 wks.) (SDS≤-2) regarding possible early postnatal anabolic effects of rhGH on protein metabolism. 5 infants received a daily subcutaneous injection with 0.5 (n = 2) or 1.0 (n=3) IU.kg−d− rhGH and 5 IUGR infants were studied as controls. Daily rhGH was started one week after birth and stopped 6-8 weeks later. At postnatal age 41 ± 15 d. protein metabolism was studied during indirect calorimetry using 1-13C-leucine turnover studies. All infants received continuous special formula feeding via a nasogastric drip {120 kcal.kg−1d−1). Results of protein intake, turnover, synthesis, breakdown, and accretion in g.kg−1,d−1 as means ± S.D. (sign, of diff. tested by Mann-Whitney U test):

ERRATA

In "Nasogastric Drip Feeding as the Only Treatment of Neonatal Maple Syrup Urine Disease" by Parini et al, published in Pediatrics (1993;92:280-283), under "Patients" on page 280, "Patients 1 and 4 each received two brief (3-hour) ETs during the first 48 hours of treatment," not patients 1 and 5. On page 282, "Growth and psychomotor development (Brunet-Lezine or Griffiths' scale) are normal in patients 1, 2, 3, and 5 (Table 2), whereas psychomotor development is delayed in patients 4, now 2 years old, probably due to the late diagnosis." should read "Growth and psychomoter development (Brunet-Lezine or Griffiths' scale) are normal in patients 1, 2, 3, and 4 (Table 2), whereas psychomotor development is delayed in patient 5, now 2 years old, probably due to the late diagnosis."

Nasogastric Drip Feeding as the Only Treatment of Neonatal Maple Syrup Urine Disease

The ideal management for severe metabolic decompensation in maple syrup urine disease (MSUD) is still debated. Most papers published in the past 20 years suggest the use of extracorporeal techniques combined with adequate caloric intake1-5 As renal clearance is poor,6 repeated and prolonged blood exchange transfusions (ETs), peritoneal dialysis, and hemodialysis have proved useful in removing branched-chain amino and keto acids (BCAAs, BCKAs) from plasma.3,7,8 However, single case reports have described good results in patients given nutritional treatment alone,9-11 and recently it has been suggested that extracorporeal techniques should be used only in selected cases, when diagnosis is made after 8 to 10 days of life and the condition is presumably life-threatening.12,13

Comparison of Short Term Indirect Calorimetry and Doubly Labeled Water Method for the Assessment of Energy Expenditure in Preterm Infants

The accuracy of 8-hour indirect calorimetry (IDC) as an estimate of energy expenditure was investigated in 8 healthy preterm infants (birth weight 1,270 +/- 193 g, gestational age 32 +/- 3 weeks, mean +/- SD) in comparison with an analysis over 5 days using the doubly-labeled water (2H2(18)O) method (DLW). The infants that were fed continuously by nasogastric drip with 120 kcal/kg/day of special infant formula were measured twice under thermoneutral conditions in a closed system indirect calorimeter during 8 h with a 4-day interval; simultaneously isotope decay was measured by isotope ratio mass spectrometry in urine samples collected daily during 5 days from 6 h after an oral dose of 2H2(18)O on the first day of IDC, all during the 4th postnatal week. The mean differences between carbon dioxide production rate (rCO2) measured either by single 8-hour IDC or by duplicate 8-hour IDC and the 5-day DLW method, using the two-point analysis or the multipoint analysis were not significantly different from zero. The rCO2 calculated from the DLW method using the two-point analysis differed -1.4 +/- 1.7% from that measured by the multipoint analysis. The mean differences between the metabolic rate estimated from 8 h of IDC and from the 5-day DLW method based on a measured RQ of 0.90 was -6.7 +/- 6.2% and based on the RQ of the feeding -4.5 +/- 6.0%. These differences were not significantly different from zero. We conclude that IDC over 8 h and two-point DLW measurement over 5 days, both methods that can be applied with relative ease in practice, offer an adequate average estimate of energy expenditure in continuously fed preterm infants under thermoneutral conditions.

Nutritional Management and Weight Changes during Hospitalization of Brazilian Infants with Diarrhoea: Primary Reliance on Oral Feeding or Continuous Nasogastric Drip with Locally Made, Modulated Minced Chicken Formula

The nutritional management of infants admitted with diarrhoea to the University Hospital of Botucatu includes a change from bolus feeding of a modulated minced-chicken formula to a continuous nasogastric drip (NGD) feeding, whenever the required calorie intake is not achieved or the diarrhoea does not subside. To evaluate this approach, the clinical course and weight changes of 63 children, aged 1-20 months, were reviewed; most (81 per cent) were below the third percentile for weight at admission and 76 per cent had a total duration of diarrhoea greater than or equal to 10 days. Associated infections, mainly systemic, were present at or after admission in 70 per cent of them. Twenty-five survivors needed nutritional support (NS), predominantly NGD, for a median duration of 30 per cent of their admission time, and were compared to 31 survivors managed without NS. Those who necessitated NS lost weight for a significantly longer median time (12 x 4 days, p less than 0.005), but their total weight loss was similar (5 x 4 per cent) as well as diarrhoea's duration (8 x 7 days). There was a tendency for a longer hospitalization (21 x 16 days 0.05 less than P less than 0.10) and a longer span to begin weight gain after diarrhoea's end for the group with NS (p less than 0.05), but subsequent growth quotient and daily weight gain during admission were similar for both groups. Both groups of survivors received similar amounts of energy, although the initial increase was delayed for those who needed the NGD.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of moderate and severe dehydration by nasogastric drip.

This study evaluates the efficacy of rehydration by nasogastric drip in children with moderate or severe dehydration and evaluates a simple system for determining the degree of dehydration. The study was conducted in Zaire. The study sample consisted of 32 children (21 males and 11 females) between the ages of 2 months and 48 months who were admitted to the pediatric ward because of dehydration. The severity of dehydration was evaluated using a points system. Mothers were encouraged to breastfeed and offer ORS by mouth during the treatment period. Following admission to the study, each child was weighed and a nasogastric tube was inserted to lie with its tip in the stomach. All mothers and children tolerated the nasogastric tube well. Edema of the eyelids was noted in 2 cases. The results indicate that a nasogastric drip is an effective means of rehydration in moderate and severe dehydration. Nasogastric infusion is also useful in treating dehydration associated with conditions such as malnutrition, pneumonia and measles. The method has proved economically advantageous to the patient by reducing the cost of treatment and the need for hospitalization.

Early enteral nutrition for mass burn injury: The revised egg-rich diet

An aggressive enteral nutritional approach has been employed to support our severely burned patients. The diet is based on a daily intake of 5 eggs/10 kg of body weight, incorporated into milkshakes. Twelve patients with severe burns (age, 24±4 years; burns, 54±12 per cent of total body surface area (TBSA)) were studied. Enteral feeding was initiated on the day of injury and gradually reached the full formula within 3–7 days. Feeding was carried out either orally or through a nasogastric drip or a combination of both, depending on the patient's condition. Each bottle of milkshake contained 2318 kJ, 29 g protein, 51 g carbohydrate and 28·6 g fat in 250 ml. Each millilitre of the diet contained 9·32 kJ. The protein provided 21 per cent of the total calorie intake, while the fat and carbohydrate provided 42 per cent and 37 per cent respectively. The mean daily intake consisted of protein (5±1·5 g/kg), carbohydrate (8±0·75g/kg) and fat (5±1g/kg), providing a daily administration of 378–420 kJ/kg. Plasma lipids remained within normal limits during the 40 days of the diet, while serum protein levels rose to normal levels within the first 3 weeks.

Necrotizing Fasciitis and Necrotizing Cellulitis Due to Group B Streptococcus

Acute necrotizing infections of the fascial planes and subcutaneous tissue produce extensive destruction of tissue, blood stream invasion by the causative pathogen, and systemic toxicity. The mortality is high. 1 This report presents two premature infants who, while recovering from their primary illness in the Neonatal Intensive Care Unit of Cook County Hospital, developed acute necrotizing infections of fascia and subcutaneous tissue due to group B streptococcus. Report of Cases .—Case1.—A 1,070-gm male infant was born by spontaneous vaginal delivery at 28 weeks of gestation with an Apgar score of 5. Severe hyaline membrane disease developed in the infant and he required mechanical ventilatory assistance for six weeks. During this period, ligation of patent ductus arteriosis was performed. At 7 weeks of age, when the infant was fairly stable and receiving nasogastric drip feedings, an episode of vomiting and apnea occurred. A red indurated swelling of the lateral

Use of an oral elemental diet in infants with severe intractable diarrhea

Twenty-seven infants from 1 day to 9 months of age with severe intractable diarrhea were fed an oral elemental diet (Vivonex) consisting of crystalline amino acids, glucose, electrolytes, and vitamins by continuous nasogastric drip. Complete control of diarrhea was achieved in 24 patients (89 percent) who had an average weight gain of 28 gm/day. Nitrogen balance and plasma amino acids were measured in five patients while they received 2.25 gm of amino acid/kd/day for two weeks and 4.58 gm of amino acid/kg/day for two weeks; the nitrogen balance and weight gain in three patients was proportional to the amino acid intake. When compared to normal levels, plasma amino acids were not appreciably increased with the lower amino acid intake. With the higher amino acid intake, there were significant increases in plasma values for 11 amino acids.

Problems encountered in the use of aluminum hydroxide gel by naso-gastric drip in the treatment of peptic ulcer

1. Problems in using the water drips were discussed briefly. 2. The new type drip developed, which was discussed, delivering a set amount without disturbing the system and using no valves, was proven to have distinct advantages over the other types. 3. Use of an electrical timing device for accurate delivery was proven to be more dependable, for once having been set, it needed no more adjustment. 4. A new type of Aluminum Hydroxide Gel was prepared, having distinct advantages because of lesser sedimentation, greater fluidity and slightly greater combining power. 5. Characteristics of a new preparation were discussed, and should have the consistency of Milk of Magnesia, a pH of 5.9, be a 5% suspension, and lastly have no more separation than 1.5 cc. when diluted for the drip method. 6. Retention of the naso-gastric tube and patient’s cooperation were discussed and an example is given. 7. Nursing care and its importance was discussed. 8. Constipation, fecal impaction, and intestinal obstruction were touched upon and the use of Vitamin B1, lubricants and enemas were found to be effective in combating them. 9. Coryza and sinusitis with their relation to the naso-gastric tube were mentioned briefly and an example given. 10. Use of Nylon as an obturator was thought to have greater advantage.