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Brazilian Journal of Otorhinolaryngology 2016Feeding difficulties in children with cleft lip and palate (CLP) are frequent and appear at birth due to impairment of sucking and swallowing functions. The use of... (Review)
Review
INTRODUCTION
Feeding difficulties in children with cleft lip and palate (CLP) are frequent and appear at birth due to impairment of sucking and swallowing functions. The use of appropriate feeding methods for the different types of cleft and the period of the child's life is of utmost importance for their full development.
OBJECTIVE
Review studies comparing feeding methods for children with CLP, pre- and postoperatively.
METHODS
The search covered the period between January 1990 and August 2015 in the PubMed, LILACS, SciELO, and Google Scholar databases using the terms: cleft lip or cleft palate and feeding methods or breastfeeding or swallowing disorders and their synonyms. This systematic review was recorded in PROSPERO under number CRD42014015011. Publications that compared feeding methods and published in Portuguese, English, and Spanish were included in the review. Studies with associated syndromes, orthopedic methods, or comparing surgical techniques were not included.
RESULTS
The three reviewed studies on the period prior to surgical repair showed better feeding performance with three different methods: squeezable bottle, syringe, and paladai bottle. Only one study addressed the postoperative period of cleft lip and/or palate repair, with positive results for the feeding method with suction. Likewise, the post-lip repair studies showed better results with suction methods. After palatoplasty, two studies showed better performance with alternative feeding routes, one study with suction method, and one study that compared methods with no suction showed better results with spoon.
CONCLUSION
The studies show that prior to surgical repair, the use of alternative methods can be beneficial. In the postoperative period following lip repair, methods with suction are more beneficial. However, in the postoperative period of palatoplasty, there are divergences of opinion regarding the most appropriate feeding methods.
Topics: Child; Cleft Lip; Cleft Palate; Feeding Methods; Humans
PubMed: 26997574
DOI: 10.1016/j.bjorl.2015.10.020 -
The Cochrane Database of Systematic... Aug 2021The balance of benefits and harms associated with enteral tube feeding for people with severe dementia is not clear. An increasing number of guidelines highlight the... (Review)
Review
BACKGROUND
The balance of benefits and harms associated with enteral tube feeding for people with severe dementia is not clear. An increasing number of guidelines highlight the lack of evidenced benefit and potential risks of enteral tube feeding. In some areas of the world, the use of enteral tube feeding is decreasing, and in other areas it is increasing.
OBJECTIVES
To assess the effectiveness and safety of enteral tube feeding for people with severe dementia who develop problems with eating and swallowing or who have reduced food and fluid intake.
SEARCH METHODS
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases and two trials registers on 14 April 2021.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), or controlled non-randomised studies. Our population of interest was adults of any age with a diagnosis of primary degenerative dementia of any cause, with severe cognitive and functional impairment, and poor nutritional intake. Eligible studies evaluated the effectiveness and complications of enteral tube feeding via a nasogastric or gastrostomy tube, or via jejunal post-pyloric feeding, in comparison with standard care or enhanced standard care, such as an intervention to promote oral intake. Our primary outcomes were survival time, quality of life, and pressure ulcers.
DATA COLLECTION AND ANALYSIS
Three review authors screened citations and two review authors assessed full texts of potentially eligible studies against inclusion criteria. One review author extracted data, which were then checked independently by a second review author. We used the 'Risk Of Bias In Non-randomised Studies of Interventions' (ROBINS-I) tool to assess the risk of bias in the included studies. Risk of confounding was assessed against a pre-agreed list of key potential confounding variables. Our primary outcomes were survival time, quality of life, and pressure ulcers. Results were not suitable for meta-analysis, so we presented them narratively. We presented results separately for studies of percutaneous endoscopic gastrostomy (PEG) feeding, nasogastric tube feeding and studies using mixed or unspecified enteral tube feeding methods. We used GRADE methods to assess the overall certainty of the evidence related to each outcome for each study.
MAIN RESULTS
We found no eligible RCTs. We included fourteen controlled, non-randomised studies. All the included studies compared outcomes between groups of people who had been assigned to enteral tube feeding or oral feeding by prior decision of a healthcare professional. Some studies controlled for a range of confounding factors, but there were high or very high risks of bias due to confounding in all studies, and high or critical risks of selection bias in some studies. Four studies with 36,816 participants assessed the effect of PEG feeding on survival time. None found any evidence of effects on survival time (low-certainty evidence). Three of four studies using mixed or unspecified enteral tube feeding methods in 310 participants (227 enteral tube feeding, 83 no enteral tube feeding) found them to be associated with longer survival time. The fourth study (1386 participants: 135 enteral tube feeding, 1251 no enteral tube feeding) found no evidence of an effect. The certainty of this body of evidence is very low. One study of PEG feeding (4421 participants: 1585 PEG, 2836 no enteral tube feeding) found PEG feeding increased the risk of pressure ulcers (moderate-certainty evidence). Two of three studies reported an increase in the number of pressure ulcers in those receiving mixed or unspecified enteral tube feeding (234 participants: 88 enteral tube feeding, 146 no enteral tube feeding). The third study found no effect (very-low certainty evidence). Two studies of nasogastric tube feeding did not report data on survival time or pressure ulcers. None of the included studies assessed quality of life. Only one study, using mixed methods of enteral tube feeding, reported on pain and comfort, finding no difference between groups. In the same study, a higher proportion of carers reported very heavy burden in the enteral tube feeding group compared to no enteral tube feeding. Two studies assessed the effect of nasogastric tube feeding on mortality (236 participants: 144 nasogastric group, 92 no enteral tube feeding). One study of 67 participants (14 nasogastric, 53 no enteral tube feeding) found nasogastric feeding was associated with increased mortality risk. The second study found no difference in mortality between groups. The certainty of this evidence is very low. Results on mortality for those using PEG or mixed methods of enteral tube feeding were mixed and the certainty of evidence was very low. There was some evidence from two studies for enteral tube feeding improving nutritional parameters, but this was very low-certainty evidence. Five studies reported a variety of harm-related outcomes with inconsistent results. The balance of evidence suggested increased risk of pneumonia with enteral tube feeding. None of the included studies assessed behavioural and psychological symptoms of dementia.
AUTHORS' CONCLUSIONS
We found no evidence that tube feeding improves survival; improves quality of life; reduces pain; reduces mortality; decreases behavioural and psychological symptoms of dementia; leads to better nourishment; improves family or carer outcomes such as depression, anxiety, carer burden, or satisfaction with care; and no indication of harm. We found some evidence that there is a clinically significant risk of pressure ulcers from enteral tube feeding. Future research should focus on better reporting and matching of control and intervention groups, and clearly defined interventions, measuring all the outcomes referred to here.
Topics: Adult; Caregivers; Dementia; Enteral Nutrition; Gastrostomy; Humans; Intubation, Gastrointestinal; Malnutrition; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 34387363
DOI: 10.1002/14651858.CD013503.pub2 -
Nutrients Apr 2022Congenital heart defects are known causes of malnutrition. Optimal nutritional management is paramount in improving short and long-term prognosis for neonates and... (Review)
Review
Congenital heart defects are known causes of malnutrition. Optimal nutritional management is paramount in improving short and long-term prognosis for neonates and infants with congenital heart malformations, as current strategies target preoperative and postoperative feeding requirements. Standardized enteral and/or parenteral feeding protocols, depending on the systemic implications of the cardiac defect, include the following common practices: diagnosing and managing feeding intolerance, choosing the right formula, and implementing a monitoring protocol. The latest guidelines from the American Society for Parenteral and Enteral Nutrition and the European Society of Paediatric and Neonatal Intensive Care, as well as a significant number of recent scientific studies, offer precious indications for establishing the best feeding parameters for neonates and infants with heart defects.
Topics: Child; Enteral Nutrition; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Malnutrition; Nutritional Status; Parenteral Nutrition
PubMed: 35458233
DOI: 10.3390/nu14081671 -
Psychiatria Polska Oct 2019Refeeding syndrome (RS) is one of the serious complications during treatment of anorexia nervosa. It includes hormonal and metabolic changes that occur during the... (Review)
Review
Refeeding syndrome (RS) is one of the serious complications during treatment of anorexia nervosa. It includes hormonal and metabolic changes that occur during the process of refeeding in chronically malnourished patient when nutrition is introduced in an excessive and improper amount. RS manifests in water-electrolyte imbalances, including hypophosphatemia (the mostimportant diagnosticmarker), hypokalemia, hyponatremia, hypomagnesaemia, fluid retention, vitamin deficiency and metabolic acidosis. It applies to either oral and parenteral supplementation. In the treatment of malnourished patients with anorexia nervosa, it is essential to establish an initial caloric amount that will stimulate weight gain from the beginning of treatment, increase its effectiveness while minimizing the risk of RS. Recent research suggests that the current recommendations may be too stringent in this respect and require further updating. Awareness of the risks associated with RS, including significant mortality, appears to be currently insufficient also among physicians. There is a need for far more specialized multidisciplinary centers for patients with anorexia nervosa and also appropriate algorithms and standards of care for that population. The aim of this paper is to systematize the current knowledge about RS and RS prevention, to increase awareness of its occurrence and present the results of the latest research on safe resupplementation of patients suffering from anorexia nervosa.
Topics: Anorexia Nervosa; Feeding Methods; Humans; Refeeding Syndrome; Water-Electrolyte Balance; Weight Gain
PubMed: 31955189
DOI: 10.12740/PP/OnlineFirst/90275 -
The American Journal of Clinical... Feb 2016The hospital discharge of premature infants in neonatal intensive care units is often delayed due to their inability to feed by mouth safely and competently. With... (Review)
Review
The hospital discharge of premature infants in neonatal intensive care units is often delayed due to their inability to feed by mouth safely and competently. With immature physiologic functions, infants born prematurely cannot be expected to readily feed by mouth at the equivalent age of a third trimester of gestation as the majority of their term counterparts do. Consequently, it is crucial that health care professionals gain an adequate knowledge of the development of preterm infants' oral feeding skills so as to optimize their safety and competency as they transition to oral feeding. With a greater sensitivity toward their immature skills, we can offer these infants a safer and smoother transition to independent oral feeding than is currently observed. This review article is an overview of the evidence-based research undertaken over the past 2 decades on the development of very-low-birth-weight infants' oral feeding skills. The description of the different functional levels where these infants can encounter hurdles may assist caregivers in identifying a potential cause or causes for their individual patients' oral feeding difficulties.
Topics: Child Development; Combined Modality Therapy; Congresses as Topic; Evidence-Based Medicine; Feeding Methods; Feeding and Eating Disorders of Childhood; Humans; Infant Behavior; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Very Low Birth Weight; Neurogenesis; Practice Guidelines as Topic; Precision Medicine; Premature Birth; Respiratory Physiological Phenomena; Respiratory System; Sucking Behavior
PubMed: 26791183
DOI: 10.3945/ajcn.115.109603 -
Nutrients Feb 2013Nutritional support of surgical and critically ill patients has undergone significant advances since 1936 when Studley demonstrated a direct relationship between... (Comparative Study)
Comparative Study Review
Nutritional support of surgical and critically ill patients has undergone significant advances since 1936 when Studley demonstrated a direct relationship between pre-operative weight loss and operative mortality. The advent of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, have allowed clinicians to treat malnutrition and improve surgical patient's outcomes. We reviewed the literature for the current status of perioperative nutrition comparing parenteral nutrition with enteral nutrition. In a surgical patient with established malnutrition, nutritional support should begin at least 7-10 days prior to surgery. Those patients in whom eating is not anticipated beyond the first five days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Compared to parenteral nutrition, enteral nutrition is associated with fewer complications, a decrease in the length of hospital stay, and a favorable cost-benefit analysis. In addition, many patients may benefit from newer enteral formulations such as Immunonutrition as well as disease-specific formulations.
Topics: Cost-Benefit Analysis; Enteral Nutrition; Humans; Immunity; Length of Stay; Malnutrition; Nutrition Assessment; Nutritional Requirements; Parenteral Nutrition; Parenteral Nutrition, Total; Perioperative Care; Perioperative Period; Postoperative Complications
PubMed: 23429491
DOI: 10.3390/nu5020608 -
Annals of Palliative Medicine Jan 2016In cancer patients, weight loss is an ominous sign suggesting disease progression and shortened survival time. As a result, providing nutrition support for cancer... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In cancer patients, weight loss is an ominous sign suggesting disease progression and shortened survival time. As a result, providing nutrition support for cancer patients has been proposed as a logical approach for improving clinical outcomes. Nutrition support can be given to patients through enteral nutrition (EN) or parenteral nutrition (PN). The purpose of the review was to compare the outcomes of PN and EN in cancer patients.
METHODS
A literature search was conducted in Ovid MEDLINE and OLDMEDLINE, Embase Classic and Embase, and Cochrane Central Register of Controlled Trials. Studies were included if over half of the patient population had cancer and reported on any of the following endpoints: the percentage of patients that experienced no infection, nutrition support complications, major complications or mortality. Risk ratios (RR) and 95% confidence intervals (CIs) using Review Manager Version 5.3 were calculated. Primary endpoints were stratified according to type of EN for subgroup analysis, grouping studies into either tube feeding (TF) or standard care (SC). Additionally, another subgroup analysis was conducted comparing studies with protein-energy malnutrition (PEM) patients and studies without PEM patients.
RESULTS
The literature search yielded 674 articles of which 36 were included for the meta-analysis. There were no difference in the endpoints between the two study interventions except that PN resulted in more infection when compared with EN (RR =1.09, 95% CI: 1.01-1.18; P=0.03).
CONCLUSIONS
Other than increased incidence of infection, PN has not resulted in prolonging the survival, increasing nutrition support complications, or major complications when compared with EN in cancer patients.
Topics: Enteral Nutrition; Humans; Infection Control; Neoplasms; Nutritional Support; Parenteral Nutrition; Protein-Energy Malnutrition; Randomized Controlled Trials as Topic
PubMed: 26841813
DOI: 10.3978/j.issn.2224-5820.2016.01.01 -
Science Progress Oct 2018Nutritionally, the first 1,000 days of an infant's life - from conception to two years - has been identified as a highly influential period, during which lasting health... (Review)
Review
Nutritionally, the first 1,000 days of an infant's life - from conception to two years - has been identified as a highly influential period, during which lasting health can be achieved. Significant evidence links patterns of infant feeding to both short and long-term health outcomes, many of which can be prevented through nutritional modifications. Recommended globally, breastfeeding is recognised as the gold standard of infant nutrition; providing key nutrients to achieve optimal health, growth and development, and conferring immunologic protective effects against disease. Nevertheless, infant formulas are often the sole source of nutrition for many infants during the first stage of life. Producers of infant formula strive to supply high quality, healthy, safe alternatives to breast milk with a comparable balance of nutrients to human milk imitating its composition and functional performance measures. The concept of 'nutritional programming', and the theory that exposure to specific conditions, can predispose an individual's health status in later life has become an accepted dictum, and has sparked important nutritional research prospects. This review explores the impact of early life nutrition, specifically, how different feeding methods affect health outcomes.
Topics: Bottle Feeding; Breast Feeding; Humans; Infant; Infant Formula; Infant Nutritional Physiological Phenomena; Infant, Newborn; Nutritive Value
PubMed: 30296969
DOI: 10.3184/003685018X15360040523721 -
World Journal of Gastroenterology Mar 2009Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of... (Review)
Review
Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute pancreatitis, gastric outlet stenosis, hyperemesis (including gravida), recurrent aspiration, tracheoesophageal fistula and stenosis in gastroenterostomy. This review discusses the differences between pre- and postpyloric feeding, indications and contraindications, advantages and disadvantages, and provides an overview of the techniques of placement of various postpyloric devices.
Topics: Digestion; Endoscopy; Enteral Nutrition; Humans; Intubation, Gastrointestinal; Jejunostomy; Jejunum; Nutritional Support; Pylorus
PubMed: 19294757
DOI: 10.3748/wjg.15.1281 -
The Effect of Enteral Tube Feeding on Patients' Health-Related Quality of Life: A Systematic Review.Nutrients May 2019Patients with functional gastrointestinal tract who are unable to meet their nutritional requirements may benefit from the use of enteral nutrition via feeding tubes...
UNLABELLED
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.
Topics: Enteral Nutrition; Humans; Quality of Life
PubMed: 31083338
DOI: 10.3390/nu11051046