Symptoms Of Feeding Intolerance Research Articles

Application of near-infrared spectroscopy in the early identification of neonatal gastrointestinal diseases

Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal diseases in neonatal intensive care units, characterized by rapid progression and a high mortality rate. Local intestinal ischemia and hypoxia are significant contributors to NEC. Feeding intolerance (FI), which refers to a range of gastrointestinal manifestations arising from the inability to tolerate enteral nutrition, is one of the most common clinical issues in neonates, and preventing and treating FI is crucial for improving neonatal survival rates. Near-infrared spectroscopy is a clinical tool that can be used at the bedside to monitor regional oxygen saturation. It is non-invasive, reliable, and sustainable, and its feasibility and safety in assessing intestinal blood circulation have been validated. Early identification of intestinal ischemia and differentiation of FI from precursor symptoms of NEC, as well as predicting the occurrence of NEC, are extremely important for reducing intestinal injury and adverse long-term outcomes. In recent years, there has been new research progress related to the monitoring of intestinal tissue oxygen saturation and cerebral oxygen saturation for the early identification of FI and precursor symptoms of NEC, and this article provides a review of these developments.

CE: Monitoring Adult Patients for Intolerance to Gastric Tube Feedings.

Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults.

Platelets and Immature Neutrophils in Preterm Infants with Feeding Intolerance.

Feeding intolerance (FI) is a common presentation of necrotizing enterocolitis (NEC) and sepsis. NEC and sepsis are associated with hematological changes, but these changes alone are not reliable biomarkers for early diagnosis. This study examined whether the combination of hematological indices and FI can be used as an early diagnostic tool for NEC or sepsis. This retrospective cohort study included infants born at <1,500 g or <30 weeks who had symptoms of FI. The exclusion criteria were congenital or chromosomal disorders, thrombocytopenia or platelet transfusion before the onset of FI, and history of bowel resection. We compared the hematological indices from infants with pathologic FI (due to NEC or sepsis) to infants with benign FI. During the study period, 211 infants developed FI; 185 met the inclusion criteria. Infants with pathologic FI (n = 90, 37 cases with NEC and 53 with sepsis) had lower birth gestational age and weight compared with 95 infants with benign FI (n = 95). Pathologic FI was associated with lower platelet count (median 152 × 103/μL vs. 285 × 103/μL, p < 0.001) and higher immature-to-total neutrophil (I/T) ratio (median 0.23 vs. 0.04, p < 0.001) at the onset of FI. Pathologic FI was also associated with a decrease in baseline platelets compared with an increase in benign FI. For diagnosis of pathologic FI, a decrease ≥10% in platelets from baseline had a sensitivity and specificity of 0.64 and 0.73, respectively, I/T ratio ≥0.1 had a sensitivity and specificity of 0.71 and 0.78, respectively, and the combination of both parameters had a sensitivity and specificity of 0.50 and 0.97, respectively. FI caused by NEC or sepsis was associated with a decrease in platelets from baseline, and a lower platelet level and higher I/T ratio at the onset of FI. These findings can help clinicians in the management of preterm infants with FI. · FI is a common presentation of NEC and sepsis in preterm infants.. · FI due to NEC or sepsis is associated with changes in platelets and I/T ratio.. · These changes could be useful as early markers for diagnosis..

Peptide-based formula versus standard-based polymeric formula for critically ill children: is it superior for patients’ tolerance?

IntroductionMalnutrition affects 50% of hospitalized children and 25–70% of critically ill children. Enteral tube feeding is generally considered the preferred modality for critically ill pediatric patients. Clinical advantages of using peptide-based formulas are still controversial in critically ill children. The aim of this study was to compare the effect of a peptide-based formula versus a standard polymeric formula on feeding tolerance and whether this will affect the outcome among critically ill children.Material and methodsThis single blind case control study was conducted on 180 randomly selected critically ill children in the pediatric critical care unit (PICU) of Ain Shams University. Patients were divided into 2 groups: a group receiving a standard polymeric formula (group 1; 90 patients) and a group receiving a peptide-based formula (group II; 90 patients). Nutritional requirements, days to reach full enteral feeding, feeding intolerance symptoms and anthropometric measurements were recorded for all patients at admission together with their pediatric risk of mortality score (PRISM). Length of PICU stay, occurrence of sepsis together with survival were analyzed at discharge as outcome measures.ResultsPatients receiving a peptide-based formula showed a significant decrease in feeding interruptions and abdominal distention (p < 0.000), reached full enteral feeding faster (2.60 ±0.74 days versus 5.36 ±1.00 days in patients received polymeric standard formula; p < 0.001) and improved weight gain (p < 0.028). Moreover, duration of sepsis was significantly shorter (p < 0.045), but no difference in mortality was recorded between patient groups.ConclusionsPeptide-based formula feeding was better tolerated than standard polymeric formula feeding in critically ill pediatric patients. However, the choice of patients receiving the peptide-based formula needs to be further evaluated.

Necrotizing Enterocolitis: Enhancing Awareness for the General Practitioner.

Necrotizing enterocolitis (NEC) has been recognized for well over 5 decades yet remains the most common life-threatening surgical emergency in the newborn. The incidence of NEC has decreased steadily in preterm and very-low-birthweight infants over several decades and is typically uncommon in term newborns and infants with a birthweight greater than 2,500 g. Evidence accumulating during the past decade, however, suggests that practitioners should consider NEC in this broader subset of term infants with chromosomal and congenital anomalies complicated by heart or gastrointestinal defects when signs and symptoms of feeding intolerance, abdominal illness, or sepsis are present. The short- and long-term consequences of NEC are devastating in all infants, and although early disease recognition and treatment are essential, promoting human milk feeding as a primary modality in prevention is critical. This article highlights our current understanding of the pathophysiology, the clinical presentation, the risk factors for NEC in term infants compared with premature infants, and the treatment of NEC and discusses strategies in the prevention of NEC. Finally, we review the long-term consequences of NEC and the importance of primary care practitioners in the long-term care of infants after hospitalization for NEC.

High-energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial.

Previous studies have shown that feeding a high-energy formula (HF) to infants after cardiac surgery increases energy intake, with fewer side effects on cardiopulmonary function. However, impacts on weight gain and gastrointestinal function remain unclear. To determine the impact of HF compared with standard formula on weight gain and gastrointestinal tolerance in postoperative infants with congenital heart disease. This was a randomized controlled trial. The setting of the study was at a 20-bed cardiac intensive care unit at a tertiary children's hospital in China. Study population included infants <1year of age who underwent cardiac surgery and were allocated to the intervention group (n = 32) or control group (n = 32). The intervention group received HF (100 kcal/100 mL), and the control group received standard formula (67 kcal/100 mL) for 7days during the stabilized postoperative period at the cardiac intensive care unit. Primary outcomes were weight gain and gastrointestinal intolerance. Secondary outcomes were energy intake and standard intensive care characteristics. Infants who received HF (n = 30) showed less weight loss than those who received standard formula (n = 29); -16 g [95% confidence interval (CI): -74 to 42] versus -181 g (95% CI: -264 to -99), P = 0·001. The evaluation of gastrointestinal intolerance showed that the intervention group had several side effects, such as abdominal distension (n = 1), gastric retention (n = 2) and diarrhoea (n = 1), while the control group had no problems. Enteral energy intake in the intervention group was higher than the control group from day three. Infants after cardiac surgery fed with HF gained more weight but had increased feeding intolerance. However, the feeding intolerance symptoms could be relieved by medication and did not affect feeding advancement. Paediatric intensive care clinicians should consider gradually increasing the energy density of the formula during feeding and assess feeding intolerance signs in some children with malnutrition after cardiac surgery.

Feeding difficulties during the neonatal period

Feeding difficulties (FD) are a major issue in neonatology, as they could hamper the assessment of an adequate enteral nutrition, delay hospital discharge and lead to breastfeeding failure. Functional and anatomical maturation of the gastrointestinal tract is strictly related to gestational age (GA); hence, premature infants are more prone to develop FD. Feeding intolerance (FI) is very common among preterm infants; clinical symptoms of FI (e.g. abdominal distension, vomiting, bilious gastric residuals, occult or gross bloody stools) are observed in nearly 29% of such neonates [1]. FI could represent an early sign of necrotizing enterocolitis (NEC), which is the most feared gastrointestinal complication of prematurity. Hence, FI often brings clinicians to withhold, decrease or discontinue enteral feeds, thus hampering the establishment of an adequate enteral nutrition and leading to a prolonged duration of both parenteral nutrition (PN) and central lines, with increased risks of such complications as liver cholestasis or sepsis[2]. The coordination between sucking, swallowing and breathing is usually achieved at 34-36 weeks GA; hence, preterm infants are usually fed via an intragastric tube, through intermittent boluses or continuously. Poor sucking and sucking-swallowing incoordination are the major causes of FD and breastfeeding failure among late preterm infants (GA 34-366/7 weeks), with an increased risk of hypoglycemia, excessive weight loss, hyperbilirubinemia, dehydration[3]. Due to FD, up to 27% of all late preterm infants need to be initially supplemented with intravenous fluids[4]; moreover, tube feeding is frequently required for feeding administration in the first days of life. The abovementioned problems are infrequent in healthy term newborns. Term neonates developing FD such as poor sucking and/or vomiting need to be evaluated for pathological causes. Physical examination could aid to identify anatomical malformations possibly responsible for FD (e.g. cleft palate). FD and sleepiness can be due to hyperbilirubinemia, hypoglycemia or electrolyte disturbances[5], but could also subtend an underlying metabolic disease, such as hypothyroidism. FD, lethargy and/or other clinical neurological signs (e.g. seizures, focal neurological signs, hypo- or hypertonia, bulging fontanel, central apnoea) could address for central nervous system diseases (i.e. subarachnoid haemorrhage, ischaemic stroke, metabolic encephalopathy etc.). FD and lethargy could also represent a warning sign for invasive infections, especially if associated with respiratory distress, apnoea and bradycardia, temperature instability and increased capillary refill time[5]. Blood tests (including blood cells count, C-reactive protein, glucose, bilirubin, electrolytes, blood gas analysis) and cerebral ultrasound scan are useful tools to aid neonatologists in the differential diagnosis.

Clinical characteristics associated with postoperative intestinal epithelial barrier dysfunction in children with congenital heart disease.

Children with congenital heart disease have loss of intestinal epithelial barrier function, which increases their risk for postoperative sepsis and organ dysfunction. We do not understand how postoperative cardiopulmonary support or the inflammatory response to cardiopulmonary bypass might alter intestinal epithelial barrier function. We examined variation in a panel of plasma biomarkers to reflect intestinal epithelial barrier function (cellular and paracellular) after cardiopulmonary bypass and in response to routine ICU care. Prospective cohort. University medical center cardiac ICU. Twenty children aged between newborn and 18 years undergoing repair or palliation of congenital heart disease with cardiopulmonary bypass. We measured baseline and repeated plasma intestinal fatty acid-binding protein, citrulline, claudin 3, and dual sugar permeability testing to reflect intestinal epithelial integrity, epithelial function, paracellular integrity, and paracellular function, respectively. We measured baseline and repeated plasma proinflammatory (interleukin-6, tumor necrosis factor-α, and interferon-γ) and anti-inflammatory (interleukin-4 and interleukin-10) cytokines, known to modulate intestinal epithelial barrier function in murine models of cardiopulmonary bypass. All patients had abnormal baseline intestinal fatty acid-binding protein concentrations (mean, 3,815.5 pg/mL; normal, 41-336 pg/mL). Cytokine response to cardiopulmonary bypass was associated with early, but not late, changes in plasma concentrations of intestinal fatty acid-binding protein 2 and citrulline. Variation in biomarker concentrations over time was associated with aspects of ICU care indicating greater severity of illness: claudin 3, intestinal fatty acid-binding protein 2, and dual sugar permeability test ratio were associated with symptoms of feeding intolerance (p < 0.05), whereas intestinal fatty acid-binding protein was positively associated with vasoactive-inotrope score (p = 0.04). Citrulline was associated with larger arteriovenous oxygen saturation difference (p = 0.04) and had a complex relationship with vasoactive-inotrope score. Children undergoing cardiopulmonary bypass for repair or palliation of congenital heart disease are at risk for intestinal injury and often present with evidence for loss of intestinal epithelial integrity preoperatively. Greater severity of illness requiring increased cardiopulmonary support rather than the inflammatory response to cardiopulmonary bypass seems to mediate late postoperative intestinal epithelial barrier function.

Minimizing tracheobronchial aspiration in patients on tube feedings, part 2

Recognize the signs and symptoms of feeding intolerance in patients on tube feedings, and learn evidence-based techniques for reducing patients' risk of tracheobronchial aspiration. Second in a two-part series.