Transpyloric Tube Research Articles

Use of transpyloric tube feeding with nonpasteurized human milk

Use of transpyloric tube feeding with nonpasteurized human milk

Duodenogastric reflux in the fasting dog: role of pylorus and duodenal motility.

A two-marker technique was used to determine duodenogastric reflux in fasting dogs with normal or surgically modified gastroduodenal junctions. All nine dogs had an esophagostomy for gastric marker perfusion. The duodenal marker was given via a duodenal fistula. In two dogs a Heineke-Mikulicz pyloroplasty was performed, and in four dogs extramucosal circular pylorectomy was performed in addition. The mean fasting duodenogastric reflux rate in dogs with a normal pylorus was 1.1 +/- 0.5 (SE) ml/10 min; after pyloroplasty it was 1.6 +/- 0.3 ml/10 min (P greater than 0.1), and after pylorectomy it was 1.5 +/- 0.4 ml/10 min (P greater than 0.1). Simultaneous intraduodenal manometry revealed no relation between the interdigestive myoelectric complex and reflux. The marker technique for the measurement of reflux was validated by pharmacologically induced reflux. Subcutaneous injection of 0.1 mg of apomorphine increased the reflux rate tenfold. A transpyloric tube increased reflux rate fivefold. It is concluded that, in the fasting dog, phenomena such as retropulsive peristalsis are determinants of duodenogastric reflux and not the presence or absence of the pylorus and normal interdigestive motility.

611 CLOTTED TRANSPYLORIC FEEDING TUBES USING A PREMATURE FORMULA

Transpyloric (TP) feeding has been used as a method of feeding the smaller (<1200 gms) infant. We have noticed that many of our infants being fed with a “reformulated” premature infant formula (Enfamil) by TP route have developed clotted feeding tubes in spite of regular irrigation with sterile water. During a 9 month period, we studied all infants fed either the premature formula or their own mothers milk via TP route. An in vitro study was also conducted comparing the premature infant formula and a standard formula with human milk placed in TP tubes at the milk's own original pH and alkaline pH.Fifty-nine infants received TP feedings; 39 were fed premature formula and 20 received human milk. Birth weight and gestational ages between the two groups were similar. No infant receiving human milk developed a clotted feeding tube. However, 15 of the 39 (38%) infants receiving premature formula developed at least one clotted tube. The clotted group was smaller in birth weight (mean of 1044 vs. 1418 gms, p<.001), and younger in gestational age (29 vs. 32 weeks, p<.05) than the non-clotted group. There were no differences between the two groups in age of initial feeding or rate of infusion. The in vitro study showed that the tubes were completely occluded, consistently, after 24 hours for the premature formula at both original pH (6.70) and alkaline pH (8.0). Neither the human milk nor the standard formula developed any clot. We feel that premature infant formulas should be used with caution when used via the transpyloric route.

Transpyloric feeding in 49 infants undergoing intensive care.

The use of transpyloric feeding in 46 very ill newborn infants requiring assisted ventilation was evaluated. It was found to be a simple and well-tolerated technique. A possible complication of significance was necrotising enterocolitis in 4 infants. Transpyloric tube feeding in 3 infants with treated upper small-bowel atresia is also described.

Radiological observations during transpyloric tube feeding in infants of low birth weight. Perforation of the duodenum and variations in normal duodenal anatomy.

Perforation of the duodenum is a serious complication of transpyloric tube feeding in infants of low birth weight. Polyvinyl chloride and (less commonly) silicone tubes have been implicated. Altered radiographic configuration of the tube in the region of the superior or inferior flexure, associated with clinical deterioration, pneumoperitoneum, peritonitis, or a retroperitoneal fistula, is diagnostic of duodenal perforation. The configuration of the tube may vary during uncomplicated transpyloric alimentation and is frequently incompatible with the expected anatomical course. Contrast examination may demonstrate normal anatomy or mobility of the distal duodenal loop as an adaptation to rigidity of the tube. The possibility of perforation appears to be increased at or adjacent to the flexures.