This study evaluated the safety and feasibility of early oral feeding (EOF) after cervical hand-sewn esophagogastric anastomosis in minimally invasive esophagectomy for esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed 80 ESCC patients undergoing thoracoscopic-laparoscopic esophagectomy (2020-2024). Based on anastomotic technique and feeding timing, patients were divided into hand-sewn (EOF on postoperative day 1) and mechanical anastomosis groups (oral feeding on days 7-9). Outcomes included operative parameters, complications, and recovery indicators. The hand-sewn group demonstrated longer duration of operation (450 vs. 390 min) but superior outcomes: less blood loss (80 vs. 100 mL), shorter hospitalization (11 vs. 16.5 days), lower pain scores (3 vs. 7), and faster gastrointestinal recovery (3 vs. 5 days) (all p < 0.001). Complication rates were significantly lower for anastomotic leakage (5.0% vs. 20.0%), pulmonary infection (17.5% vs. 42.5%), and pleural effusion (40.0% vs. 67.5%) (all p < 0.05). No differences were found in chylothorax or anastomotic stricture. Early oral feeding following hand-sewn cervical anastomosis is safe and feasible in selected ESCC patients, promoting faster recovery with fewer complications, and should be incorporated into enhanced recovery protocols.

Abstract In this issue of The Journal of Clinical Ethics, persons who knew bioethicist and lawyer Nancy Dubler celebrate her and the most important contributions she made to the practice of clinical ethics consultation (CEC). Her insights and the many discussions here include the unmet needs of prisoners, optimal approaches to bioethics mediation that prioritize the feelings of and relations between people, ethics consultants asking families of patients who can't speak for themselves what the patient was like as a person before they discuss ethics, allocating resources consistently and fairly, learning CEC by role-playing in disempowered roles, distinguishing what is ethical from what is legal, increasing contributions from nonmedical people, increasing interconnections between health systems and the broader bioethics community, replacing oral feedings with tube feedings, fostering substitute decision makers whom patients most want, and appreciating root causes of patients' and families' mistrust. All these topics are likely to be optimal CEC practices, if not already implemented.

Oral feeding of egg yolk antibody provide passive immune protection against largemouth bass iridovirus.

Computed tomography radiomic analysis of paraspinal muscles in the prognosis of advanced head and neck cancers.

Introduction STING-associated vasculopathy with onset in infancy (SAVI) is a rare monogenic autoinflammatory disease characterised by activation of the type I interferon (IFN-I) signalling pathway. Emerging evidence suggests that direct inhibition of the type I interferon receptor (IFNAR1) may provide superior therapeutic response and less treatment-emergent infective side effects than conventional JAK inhibition. We describe the case of a 2-year-old female with a de novo pathogenic TMEM173 variant who was born extremely preterm at 24+6 weeks as a dichorionic diamniotic twin and with a maternal history of undifferentiated autoimmune disease. Her clinical course was complicated by gastrointestinal dysregulation, including severe vomiting, failure to thrive, and hepatitis, alongside cutaneous manifestations such as vasculitis. Methods The patient was initially managed with ruxolitinib (JAK inhibitor) and systemic corticosteroids. Attempts to taper prednisolone below 3 mg daily were associated with recurrence of vomiting and weight loss. Anifrolumab (anti-IFNAR1 antibody) was subsequently commenced under compassionate access, and close monitoring of clinical progress, growth parameters, inflammatory markers, and type I interferon signature was undertaken. Results Initiation of anifrolumab led to gradual but sustained clinical improvement with resolution of rash, successful transition to full oral feeding, and improved weight gain. This enabled the tapering and eventual discontinuation of both ruxolitinib and corticosteroids. Concurrently, normalisation of the interferon gene signature was achieved. Mild elevations in C-reactive protein, erythrocyte sedimentation rate, IgG, and platelet count persist, suggesting residual low-grade systemic inflammation versus active disease. Conclusion This case underscores the potential of targeted IFNAR1 inhibition with anifrolumab as an effective steroid-sparing agent in paediatric SAVI. Direct interferon blockade may represent a preferred therapeutic pathway in IFN-I–driven monogenic autoinflammatory disorders.

Background: Premature birth is associated with many medical conditions including feeding and swallowing difficulties. Despite the existing knowledge on caregivers’ experiences, there is a dearth of literature that has explored experiences of caregivers whose infants have feeding difficulties in the neonatal intensive care unit (NICU) in South Africa. Objectives: This study explored experiences of caregivers of premature infants diagnosed with feeding difficulties in the NICU within the South African context. Method: This study was conducted using an explorative qualitative design. Data were collected using an anonymous qualitative survey distributed through caregiver social media support groups. Purposive sampling was used to recruit 9 participants. Data were analysed using inductive thematic analysis. Results: Three main themes emerged, namely: (1) Emotional distress associated with infants’ feeding and swallowing difficulties and prematurity, (2) infants’ inability to feed orally and NICU restrictions: barriers to caregiver-infant attachment and bonding, and (3) caregiver informational needs regarding oral feeding and general child care. Conclusion: This study indicates the need for holistic family-centred healthcare practices within the NICU. Therefore, in addition to providing oral-sensorimotor intervention to infants with feeding and/or swallowing difficulties, speech-language therapists (SLTs) need to ensure that caregiver needs and concerns related to their child are addressed. Moreover, SLT interventions need to consider caregiver-infant attachment and bonding strategies in the absence of oral feeding. Contribution: This study highlights the need for family-centred care practices within the NICU, which considers informational needs, inclusion in oral-sensorimotor intervention, and the psychosocial needs of caregivers.

Coordination of sucking-swallowing-breathing matures at 32 to 34 weeks' gestation; early oral feeds risk aspiration, while delays may increase oral aversion and length of stay. Safety of feeding on high-flow nasal cannula (HFNC) or continuous positive airway pressure (CPAP) is uncertain, and practice variations are common. This study describes the U.S. neonatal intensive care unit (NICU) practices for oral feeding during HFNC/CPAP and decision criteria.National cross-sectional telephone survey (July 2024-February 2025) of key informants from level III and IV NICUs.Of 159 NICUs, 83.0% routinely permitted oral feeding on HFNC, 10.7% sometimes, and 6.3% never. Only 9.4% routinely allowed CPAP feeding, 7.5% sometimes, and 83.0% never. Units allowing CPAP feeding used stricter readiness criteria, continuous monitoring, and involved speech-language pathology/occupational therapy.Oral feeding on HFNC is common; CPAP feeding is rare and criteria-bound, with regional variation. Heterogeneity underscores the need for consensus guidance and trials evaluating CPAP feeding effects on feeding outcomes, length of stay, and neurodevelopment. · Oral feeding during noninvasive support is widespread for HFNC but far more selective on CPAP.. · Units that permit CPAP feeding use strict criteria and multidisciplinary evaluation.. · Considerable variability across units and regions highlights the need for standardized guidance..

Nutritional management strategies for long-term ICU patients remain insufficiently established. This study evaluated the association between implementing an enhanced nutrition support system and enteral nutrition (EN) adequacy and related care indicators in patients with prolonged ICU stay. In this single-center retrospective study, 85 adults with ICU stay ≥ 14days were assigned to the conventional (January 2019 to October 2021; n = 48) or enhanced (November 2021 to March 2024; n = 37) groups based on hospital adoption of the enhanced nutrition support system, without patient-level prospective assignment or randomization. During the enhanced period, this system-comprising full-time dietitian assignment, standardized EN protocols for oral and tube feeding, systematic nutritional assessment, and intolerance management-was provided as routine care from ICU day 1. All variables were retrospectively abstracted from electronic medical records. Primary outcomes were presence of EN on day 14 (oral and/or tube), presence of oral intake on day 14, and daily EN adequacy (energy and protein sufficiency) over ICU days 1-14. Secondary outcomes included ratio of central venous catheter (CVC) placement days, antibiotic administration days ratio, positive blood culture rates, and incidence of gastrointestinal intolerance symptoms (diarrhea, constipation, vomiting). On day 14, the enhanced group showed significantly higher rates of EN presence (78.4% vs. 52.1%, p = 0.013) and oral intake presence (35.1% vs. 12.5%, p = 0.013) than did the conventional group. Significant group-by-day interactions for energy and protein adequacy rates (both, p < 0.001) indicated steeper increases over time in the enhanced group. The median ratio of CVC placement days was lower in the enhanced group than in the conventional group (35.1% vs. 63.1%, p = 0.035). No significant differences were found between the groups in gastrointestinal intolerance symptoms, antibiotic administration days ratio, or positive blood culture rates. Implementation of an enhanced nutrition support system was associated with higher EN adequacy, higher day-14 EN and oral intake rates, and lower CVC use in long-term ICU patients, without increasing gastrointestinal intolerance. These findings support the adoption of multidisciplinary, protocol-based nutrition support as a standard approach for ICU patients at high nutritional risk.

Background: The premature infant oral motor intervention (PIOMI) has demonstrated benefits in improving oral feeding abilities and reducing hospitalization duration in preterm neonates. However, evidence from rural health care settings, particularly in India, remains sparse. Objective: This study aimed to evaluate the effect of PIOMI combined with routine neonatal care versus routine care alone on the transition time from gavage feeding initiation to full breastfeeding in preterm neonates. Methods: A randomized controlled trial was conducted with 202 hemodynamically stable preterm neonates of 28-32 weeks' gestation admitted to the NICU and SNCU of a rural tertiary care center in India. Participants were randomized into an intervention group receiving PIOMI plus routine care-which included Kangaroo Mother Care and non-nutritive sucking-and a control group receiving routine care alone. Neonates were stratified by gestational age into four categories: 28-29, 29-30, 30-31, and 31-32 weeks. The primary outcomes were times to achieve full katori spoon feeding and full breastfeeding. Secondary outcomes included weight gain from day 14 to day 20 of life. Results: The intervention group achieved initial katori spoon feeding earlier by 0.71 days (95% CI: -1.30 to -0.12; p = 0.017), full katori spoon feeding 6.89 days sooner (95% CI: -8.13 to -5.65; p < 0.001), and full breastfeeding 5.71 days earlier (95% CI: -7.02 to -4.40; p < 0.001) than the control group. Average weight gain between days 14 and 20 was modestly lower in the intervention group by 5.36 g/day (95% CI: -6.48 to -4.25; p < 0.001). Conclusions: PIOMI significantly shortened the transition from gavage to full breastfeeding in preterm neonates in a rural Indian setting, although with a slight reduction in weight gain during the latter hospital stay period.

To investigate the effect of Infant-Driven Feeding (IDF) on feeding outcomes and growth among preterm infants with a gestational age of 32 to 37weeks at birth in the neonatal intensive care unit (NICU). An interventional study was conducted to evaluate the effectiveness of an IDF protocol compared to a standard feeding regimen. The control group (N=88) received the standard feeding protocol, while the experimental group (N=92) received the IDF protocol. Data were collected between January 1 and December 31, 2022. The experimental group exhibited a higher average oral milk intake per minute than the control group (t =-7.762, P <.001). Additionally, the experimental group achieved full oral feeding in a significantly shorter time (t =4.434, P <.001) compared to the control group. The experimental group also had a shorter nasogastric tube indwelling time (t =4.372, P <.001) and length of hospital stay (t=3.682, P <.001) compared to the control group. During the first week of life, the experimental group showed no significant differences in length (t=-1.475, P =.142), head circumference (t=-0.410, P =.683); however, weight gain on the 7th day was greater in the experimental group (t=-2.260, P =.025) when compared to the control group. The experimental group had a significantly lower incidence of vomiting (χ2=5.327, P =.021), oxygen desaturations (χ2=5.715, P =.017), and milk choking (χ2=6.105, P =.013) as compared to control group. There were no significant differences in the incidence of necrotizing enterocolitis (NEC) between the 2 groups (χ2=-1.071, P =.284). The implementation of IDF protocol in preterm infants with a gestational age of 32 to 37weeks at birth in the NICU improved feeding outcomes, expedited the feeding process, and reduced complications associated with poor feeding. Moreover, it did not adversely affect the growth and development of these infants and enhanced their feeding safety.

Background: Intrapartum-related complications, including intrapartum hypoxia and subsequent hypoxic ischemic encephalopathy (HIE), are the second leading cause of neonatal deaths in South Africa. Complications may be associated with a substantial burden of impairment, including dysphagia. Objectives: To describe the feeding and swallowing profile of neonates with HIE in a neonatal unit in Cape Town, South Africa. Method: A descriptive, exploratory, longitudinal study of 52 participants with varying severities of HIE is presented. Clinical feeding and swallowing assessments were conducted with 13 prospective participants using the Neonatal Feeding Assessment Scale, and medical folder reviews were conducted for 39 retrospective participants. Data were analysed using descriptive and inferential statistics. Results: A median of 4 days (p = 0.036) to oral feeding readiness and 5 days (p = 0.016) to full oral feeds was observed. Participants with a severely abnormal initial amplitude-integrated electroencephalography who did not receive hypothermia treatment demonstrated significantly longer times for both outcomes. Participants across all severities presented with feeding and swallowing difficulties, primarily in the oral phase. Most participants (96.2%) were discharged on full oral feeds, while the remaining 3.8% were discharged on nasogastric tube feeds while awaiting gastrostomy placement. Conclusion: Regardless of severity, neonates with HIE are at increased risk of feeding and swallowing difficulties. Thus, early identification and management before discharge from the neonatal unit, and long-term follow-up of infants with HIE, are recommended. Contribution: This study contributes to the small body of research on feeding and swallowing difficulties in neonates with HIE and may guide future research.

IntroductionIn Africa, where access to timely and safe surgical care remains limited, postoperative complications and prolonged hospital stays continue to challenge health systems. The Enhanced Recovery After Surgery (ERAS) protocol has been shown to improve perioperative outcomes by reducing hospital length of stay (LOS) and complications, but compliance remains inconsistent.ObjectiveTo determine whether improving ERAS compliance in Ethiopia, through a “Triple Intervention Strategy” of early postoperative feeding, ambulation, and urinary catheter removal, could reduce hospital LOS for patients undergoing laparotomy and cesarean section (CS).MethodsThis study was designed as a cluster-randomized clinical trial conducted across 10 hospitals within the National Perioperative Quality Improvement Network (NaPQIN) in Ethiopia. Hospitals were randomly assigned to either the intervention group (n=5), which received structured ERAS training reinforced through continuous monitoring and supervision, or the control group (n=5), which continued standard perioperative care without additional reinforcement. The primary outcome was hospital LOS, and secondary outcomes included compliance with the ERAS components, determinants of LOS, and postoperative complications. Data were managed through the NaPQIN platform and analyzed using R statistical software.ResultsA total of 8,256 patients were enrolled, with 5,887 (71.3%) in the intervention group and 2,369 (28.7%) in the control group. Full compliance with the ERAS bundle improved to 76.5% in the intervention group compared to 57.9% in controls (p < 0.001). Patients in the intervention group had a significantly shorter LOS (mean 80.75 vs. 89.24 hours; p < 0.001). The intervention group also had significantly fewer postoperative complications (2.1% vs 4.8%; p < 0.001), and more patients were discharged without any complications.Conclusions and RelevanceThis pragmatic trial, enabled by a national perioperative data system, demonstrated that the targeted implementation of postoperative ERAS elements, early oral feeding, mobilization, and timely urinary catheter removal significantly improved compliance and reduced hospital stay without requiring additional resources. While full ERAS pathways remain the ideal, focused, context-adapted strategies can offer scalable benefits in LMIC settings burdened by surgical backlogs and limited perioperative capacity. Broader adoption should prioritize tailored integration, ongoing evaluation, and provider engagement to maximize system-wide impact.Trial Registration:pactr.samrc.ac.za identifierPACTR202502863551536

Craniofacial microsomia (CFM) presents with variable underdevelopment of craniofacial structures. The clinical severity varies widely and may lead to airway compromise and feeding difficulties in neonates. Herein, we describe a rare case of unilateral CFM with a severe Tessier number 7 cleft, complete mandibular agenesis, ear deformities, and extensive intraoral adhesions. Particularly, adhesions between the tongue and oral mucosa induced a deficiency of reconstructable soft tissue, making the release of the adhesion challenging and complicating the timing of surgical intervention. The patient required tracheostomy for respiratory distress and was fed via a nasogastric tube due to severe Tessier number 7 cleft, which caused significant difficulty with oral feeding. Considering the need for oral feeding and the anatomical challenges, surgical intervention was performed on day 70. The procedure involved removal of intraoral adhesions, separation of the oral cavity from the external face to restore functional integrity, and reconstruction of the oral commissure. This allowed initiation of oral feeding and facilitated aesthetic improvement without complications. This case illustrates a severe form of CFM and highlights the importance of timely, growth-adapted interventions to restore essential functions.

Dysphagia poses a significant concern, particularly within the pediatric population due to the heightened susceptibility of children to silent aspiration, which can lead to numerous complications such as aspiration pneumonia, failure to thrive, dehydration, and poor quality of life. This study aimed to review the duration and extent of postoperative dysphagia-related symptoms and outcomes. A retrospective review was conducted to assess the Functional Oral Intake Scale for Children (FOIS), a grading system used to assess the degree of dysphagia, preoperatively and postoperatively in pediatric patients aged < 14 years who underwent airway procedures between January 2020 and February 2024. A total of 28 patients (mean age, 20.05 ± 23.89 months) underwent 37 airway procedures. Among them, 25 (67.6%) were male. The most frequently performed procedures were balloon dilatation (with or without laser) and supraglottoplasty, each accounting for 27% of the surgeries. Postoperative outcomes revealed a mean dysphagia duration of 17.29 ± 42.55 days, with the longest duration observed in patients undergoing vocal cord lateralization (mean: 106.5 ± 146.37 days). Additionally, the ability to feed orally declined postoperatively, with the proportion of patients capable of oral feeding decreasing from 64.9% (24 patients) preoperatively to 40.5% (15 patients) postoperatively. Overall, the FOIS scores increased in the study population. Preoperatively, 10 patients (27%) were classified as FOIS level 1, compared with six patients (16.2%) postoperatively. Additionally, the number of patients with FOIS level 2 increased from three (8.1%) preoperatively to six (16.2%) postoperatively. Our study revealed the prevalence and variability of dysphagia in pediatric patients following airway surgery. The duration of postoperative dysphagia in our study population was the longest for vocal fold lateralization procedures, followed by laryngotracheal reconstruction and supraglottoplasty. Children with pre-existing dysphagia, or those who were tube-dependent before surgery, were found to be at a higher risk for experiencing prolonged and persistent feeding difficulties. We highlight the importance of identifying high-risk patients before surgery and routine postoperative swallowing assessments. This should be followed by the involvement of a multidisciplinary care team.

Objective: To evaluate the effect of fiberoptic endoscopic evaluation of swallowing (FEES) on clinical functional outcomes of patients with intensive care unit-acquired swallowing disorders (ICU-ASD). Methods: This retrospective cohort study analyzed clinical data of patients diagnosed with post-extubation dysphagia (PED) in the intensive care unit (ICU) and respiratory intensive care unit (RICU) of the Affiliated Hospital of Inner Mongolia Medical University from February 2020 to February 2025. Patients were categorized into a FEES group of 60 cases [34 males, 26 females, aged 37-80 years (median age 62 years)] and a control group without FEES of 58 cases [32 males, 26 females, aged 39-77 years (median age 61 years)].The patients in two groups received swallowing function and feeding training based on the results of the FEES assessment and the Volume-Viscosity Swallow Test-Clinical Version (VVST-CV), respectively. Clinical functional outcome measures included pneumonia incidence, clinical pulmonary infection score (CPIS), pneumonia severity index (PSI), Functional Oral Intake Scale (FOIS), and dietary method at discharge. χ² test, Mann-Whitney U test, and Wilcoxon signed-rank test, were employed for statistical analysis of the outcome measures. Results: Compared with the control group, the FEES group had significantly lower aspiration pneumonia incidence at discharge [3.3% (2/60) vs 15.5% (9/58), χ²=5.179, P=0.023]. Regarding dietary methods,a significantly higher proportion of patients in the FEES group achieved complete oral feeding compared with the control group [75.0% (45/60) vs 67.3% (39/58), χ²=8.065, P<0.05]. After training, the FEES group had higher median FOIS scores than the control group (7.00 vs 6.00, Z=-2.370, P=0.018), and lower CPIS scores (2.50 vs 5.00, Z=-2.216, P=0.027) and PSI scores (59.00 vs 73.00, Z=-2.251, P=0.024). Within-group comparisons revealed that FOIS scores significantly improved post-training in both groups (both P<0.001). Conclusion: Early FEES examination for ICU patients with acquired swallowing disorders is associated with a lower incidence of pneumonia, improved swallowing function, and superior clinical functional outcomes.

Introduction: Feeding difficulties are common following neonatal surgery for congenital heart disease (CHD) and often lead to tube assisted feeding (TAF), defined as feeding via enteral tube, alone or in combination with oral feeding. TAF places a burden on families and healthcare resources and may serve as a barrier to normal infant development. Risk factors for TAF in the CHD population are poorly defined. Our primary aim was to identify patient characteristics and clinical outcomes associated with TAF at hospital discharge in neonates after cardiac surgery. Methods: This was a multicenter retrospective analysis of infants with CHD and an index neonatal cardiac operation at ≤30 days of age who survived to hospital discharge. Data included all acute care cardiology unit (ACCU) and cardiac intensive care unit (CICU) encounters sourced from the Pediatric Acute Care Cardiology Collaborative and Pediatric Cardiac Critical Care Consortium databases 2/2019-12/2023. Patients with tracheostomy were excluded. Comparative statistics were used to evaluate factors associated with exclusive oral feeding versus TAF at discharge. Results: Among 5,541 encounters (5,538 patients) from 34 centers, 58% were discharged with TAF. TAF patient characteristics included female sex, prematurity, genetic abnormalities (p&lt;0.0001 for all) and non-Hispanic ethnicity (p=0.009), Table 1. These patients had higher index operation STAT category and maximal vasoactive inotropic score, longer chest open and postoperative ventilator days, and more postoperative oral reintubations (p&lt;0.0001 for all). They were fed preoperatively less and postoperative feeds were initiated later (p&lt;0.0001 for all). TAF patients had longer CICU and ACCU length of stay and higher ACCU readmission rate (p&lt;0.0001 for all). Patients in the Southern region had higher rates of exclusive oral feeding (p&lt;0.0001). Conclusion: In this large multi-institutional cohort, more than 50% of infants were discharged with TAF after neonatal cardiac surgery. Postoperative reintubation, ventilator days, and timing of preoperative and postoperative oral feeding were identified as independent risk factors for TAF. These could be targets for development of a multivariable model to identify variables that may predict which patients require TAF, aiding in both counseling for families and resource utilization.

The impact of an individually tailored, stepwise nutrition protocol on energy and protein adequacy in post-ICU patients: The PROSPECT-II observational cohort study.

Effectiveness of an oral-motor intervention for premature infants: Feeding and maternal self-efficacy.

IgY antibodies as a non-antibiotic approach to combat Vibrio vulnificus infection and gut microbiota dysbiosis in zebrafish.

INTRODUCTION: Esophagectomy (EE) with immediate esophagoplasty is a high-risk procedure associated with frequent complications and hospital mortality. Enhanced recovery after surgery protocols, including early oral feeding (EOF), have been developed to improve outcomes. However, EOF’s safety in esophageal surgery is often questioned, with preference given to enteral nutrition through jejunostomy. OBJECTIVE: To evaluate the effect of EOF after EE with immediate esophagoplasty on postoperative complications and laboratory blood test dynamics. MATERIALS AND METHODS: A retrospective study of 500 elective EE with immediate esophagoplasty performed at A.V. Vishnevsky National Medical Research Center of Surgery from 2012 to 2024. Patients were treated under the rationally accelerated perioperative rehabilitation program (RAPOR). EOF was allowed for 96 (19.2 %) patients with satisfactory cervical anastomosis quality and no aspiration or anastomosis insufficiency during X-ray control. The remaining patients received full parenteral nutrition for 5 days. Laboratory parameters (albumin, prealbumin, transferrin and absolute lymphocyte account) were evaluated before surgery and on days 1, 3–5, and 8–10 post-surgery. RESULTS: The EOF group showed lower complication rates compared to the standard management group (14.6 % vs. 32.7 %, p &lt; 0.001), including lower anastomosis insufficiency/necrosis of the conduit (4.2 % vs. 7.2 %, p = 0.04). Hospitalization duration decreased from 10 to 8 days (p &lt; 0.05). EOF reduced complication likelihood by 50 % (5–75 %). However, the EOF group included younger and less comorbid patients after shorter interventions. The EOF group had significantly higher average albumin levels 3–5 days post-surgery. CONCLUSIONS: As part of the RAPOR program, early oral feeding in patients after EE with immediate esophagoplasty is effective and safe. However, further intercenter studies are needed.