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Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review.Annals of Palliative Medicine Jul 2021Nutrition supports is essential to the prognosis of stroke patients with dysphagia. It's necessary to evaluate the effects and safety of intermittent tube feeding for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nutrition supports is essential to the prognosis of stroke patients with dysphagia. It's necessary to evaluate the effects and safety of intermittent tube feeding for stroke patients with dysphagia, to provide evidence for the management of dysphagia.
METHODS
Cochrane Library et al. databases were searched for randomized controlled trials (RCTs) on the intermittent tube feeding for stroke patients with dysphagia up to Feb 15, 2021. Bias risk assessment tool recommended by Cochrane was used for quality assessment, and Revman5.3 software was used for data analysis.
RESULTS
A total of 11 RCTs involving 762 stroke patients with dysphagia were included. Meta-analysis indicated that intermittent tube feeding could significantly increase the rate of dysphagia function improvement [odd ratio (OR ) = 5.22, 95% confidence interval (CI): 3.38-8.07], serum albumin level [mean difference (MD) = 3.07, 95% CI: 1.65-4.49], hemoglobin level (MD =1.55, 95% CI: 1.19-1.95), prealbumin level (MD =1.79, 95% CI: 1.46-2.12), and reduce the incidence of aspiration pneumonia (OR = 0.28, 95% CI: 0.15-0.53), incidence of aspiration (OR =0.27, 95% CI: 0.08-0.93) for stroke patients with dysphagia (all P<0.05), o significant difference in the triceps skinfold thickness (TSF) (MD =0.46, 95% CI: -0.24 to 1.19) and arm muscle circumference (MD =0.04, 95% CI: -0.28 to 0.36) between two groups were found (all P>0.05). Egger regression tests indicated that there was no publication bias between included RCTs (all P>0.05).
DISCUSSION
Intermittent tube feeding for stroke patients with dysphagia during the recovery period can not only ensure the nutritional supply, but also promote the recovery of swallowing function and reduce the occurrence of aspiration and aspiration associated pneumonia.
Topics: Deglutition Disorders; Enteral Nutrition; Humans; Nutritional Status; Stroke
PubMed: 34353034
DOI: 10.21037/apm-21-736 -
Maternal and Child Health Journal Aug 2016Objective WHO and UNICEF recommend cup feeding for neonates unable to breastfeed in low-resource settings. In developed countries, cup feeding in lieu of bottle feeding... (Review)
Review
Objective WHO and UNICEF recommend cup feeding for neonates unable to breastfeed in low-resource settings. In developed countries, cup feeding in lieu of bottle feeding in the neonatal period is hypothesized to improve breastfeeding outcomes for those initially unable to breastfeed. Our aim was to synthesize the entire body of evidence on cup feeding. Methods We searched domestic and international databases for original research. Our search criteria required original data on cup feeding in neonates published in English between January 1990 and December 2014. Results We identified 28 original research papers. Ten were randomized clinical trials, 7 non-randomized intervention studies, and 11 observational studies; 11 were conducted in developing country. Outcomes evaluated included physiologic stability, safety, intake, duration, spillage, weight gain, any and exclusive breastfeeding, length of hospital stay, compliance, and acceptability. Cup feeding appears to be safe though intake may be less and spillage greater relative to bottle or tube feeding. Overall, slightly higher proportions of cup fed versus bottle fed infants report any breastfeeding; a greater proportion of cup fed infants reported exclusive breastfeeding at discharge and beyond. Cup feeding increases breastfeeding in subgroups (e.g. those who intend to breastfeed or women who had a Caesarean section). Compliance and acceptability is problematic in certain settings. Conclusions Further research on long-term breastfeeding outcomes and in low-resource settings would be helpful. Research data on high risk infants (e.g. those with cleft palates) would be informative. Innovative cup feeding approaches to minimize spillage, optimize compliance, and increase breastfeeding feeding are needed.
Topics: Breast Feeding; Cooking and Eating Utensils; Enteral Nutrition; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Pregnancy
PubMed: 27016350
DOI: 10.1007/s10995-016-1961-9 -
The Cochrane Database of Systematic... Jul 2019Enteral tube feeding is routinely used in many cystic fibrosis centres when oral dietary and supplement intake has failed to achieve an adequate nutritional status. The...
BACKGROUND
Enteral tube feeding is routinely used in many cystic fibrosis centres when oral dietary and supplement intake has failed to achieve an adequate nutritional status. The use of this method of feeding is assessed on an individual basis taking into consideration the patients age and clinical status. This is a final update of a previously published review.
OBJECTIVES
To examine the evidence that in people with cystic fibrosis, supplemental enteral tube feeding improves nutritional status, respiratory function, and quality of life without significant adverse effects.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also contacted the companies that market enteral feeds and reviewed their databases.Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 10 July 2019.Date of the most recent hand search of PubMed: 26 October 2018.
SELECTION CRITERIA
All randomised controlled trials comparing supplemental enteral tube feeding for one month or longer with no specific intervention in people with cystic fibrosis.
DATA COLLECTION AND ANALYSIS
The searches identified 44 trials; however, none were eligible for inclusion in this review.
MAIN RESULTS
There are no trials included in this review.
AUTHORS' CONCLUSIONS
Supplemental enteral tube feeding is widely used throughout the world to improve nutritional status in people with cystic fibrosis. The methods mostly used, nasogastric or gastrostomy feeding, are expensive and may have a negative effect on self-esteem and body image. Reported use of enteral tube feeding suggests that it results in nutritional and respiratory improvement; but, efficacy has not been fully assessed by randomised controlled trials. It is acknowledged, however, that performing a randomised controlled trial would be difficult due to the ethics of withholding an intervention in a group of people whose nutritional status necessitates it.
Topics: Cystic Fibrosis; Dietary Supplements; Enteral Nutrition; Humans; Nutritional Status; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 31328789
DOI: 10.1002/14651858.CD001198.pub5 -
Danish Medical Journal Jul 2022We aimed to determine if changing nasogastric feeding tubes more often would impact colonisation of the upper gastrointestinal tract of the premature infant. (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
We aimed to determine if changing nasogastric feeding tubes more often would impact colonisation of the upper gastrointestinal tract of the premature infant.
METHODS
We included 22 neonates born less-than 32 weeks gestation within 48 hours after birth. The neonates were randomised to have their feeding tubes changed on day seven or daily during the first week of life. We determined the bacterial concentration by the culture method in maternal milk samples, gastric aspirates and feeding tube flushes. Bacteria were identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF). The primary outcome was the concentration of bacteria in the gastric aspirate from a freshly placed nasogastric tube on day seven of life.
RESULTS
Data from only 11 neonates were eligible for primary outcome analysis. We found no difference in bacterial concentration between the two groups with a mean colony-forming unit count per ml aspirate of 4.62 log10 (standard deviation (SD): ± 3.43) in the intervention group and 2.76 log10 (SD: ± 3.13) in the control group. Data from 19 neonates were eligible for analysis of secondary outcome measures. We found no statistically significant differences in the composition of the bacterial load between the two groups. Infants with a lower gastric pH had lower gastric bacterial counts.
CONCLUSION
Changing the feeding tube daily rather than weekly in the first week of life did not result in reduced bacterial concentration in gastric aspirates. The bacterial load from the feeding tubes was low suggesting that contamination of feeding tubes did not affect early colonisation of the upper gastrointestinal tract.
FUNDING
none.
TRIAL REGISTRATION
ClinicalTrials identification number NCT02830503.
Topics: Enteral Nutrition; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intubation, Gastrointestinal; Stomach
PubMed: 35959833
DOI: No ID Found -
Journal of Cystic Fibrosis : Official... Nov 2016Nutrition is integral to the care of individuals with cystic fibrosis (CF). Better nutritional status is associated with improved pulmonary function. In some individuals... (Review)
Review
Nutrition is integral to the care of individuals with cystic fibrosis (CF). Better nutritional status is associated with improved pulmonary function. In some individuals with CF, enteral tube feeding can be useful in achieving optimal nutritional status. Current nutrition guidelines do not include detailed recommendations for enteral tube feeding. The Cystic Fibrosis Foundation convened an expert panel to develop enteral tube feeding recommendations based on a systematic review of the evidence and expert opinion. These guidelines address when to consider enteral tube feeding, assessment of confounding causes of poor nutrition in CF, preparation of the patient for placement of the enteral feeding tube, management of the tube after placement and education about enteral feeding. These recommendations are intended to guide the CF care team, individuals with CF, and their families through the enteral tube feeding process.
Topics: Cystic Fibrosis; Enteral Nutrition; Humans; Nutritional Status; Practice Guidelines as Topic
PubMed: 27599607
DOI: 10.1016/j.jcf.2016.08.004 -
Journal of Pediatric Surgery Nov 2023Nutritional complications have an impact in both short- and long-term morbidity of patients with congenital diaphragmatic hernia (CDH). We aimed to compare time to full...
BACKGROUND
Nutritional complications have an impact in both short- and long-term morbidity of patients with congenital diaphragmatic hernia (CDH). We aimed to compare time to full enteral tube feeding depending on route -gastric (GT) or transpyloric (TPT)- in newborns with left CDH (L-CDH).
METHODS
Retrospective cohort study of L-CDH patients admitted to a referral tertiary care NICU between January 2007 and December 2014. Lethal chromosomal abnormalities and death before initiation of enteral nutrition were exclusion criteria.
RESULTS
37 patients were fed through GT, 46 by TPT. TPT children took 11.0 (6.8) days to reach full enteral tube feeding and spent 16.6 (8.1) days on parenteral nutrition vs 16.8 (14.7) days (p = 0.041) and 22.7 (13.5) days (p = 0.020) of GT patients. TPT children had 3.9 (2.4) days of fasting due to GI issues and 20% had episodes of decreased rates of enteral nutrition for extra-GI complications vs 11.4 (11.1) days (p = 0.028) and 49% (p = 0.006). According to the best fitting model (R 0.383, p < 0.001), the TPT-group achieved full enteral feeding 8.4 days earlier than the GT-group (95% CI -14.76 to - 2.02 days), after adjustment by severity of illness during the first days, o/e LHR_liver and class of diaphragmatic defect. There were no differences in growth outcomes and length of stay between survivors of GT and TPT groups.
CONCLUSION
TPT shortens time to full enteral nutrition, especially in the most severe L-CDH patients. We propose that placement of a TPT at the end of the surgical repair procedure should be considered, especially in higher-risk patients.
LEVEL OF EVIDENCE
Treatment study, Level III. Retrospective comparative, case-control study.
Topics: Child; Humans; Infant, Newborn; Hernias, Diaphragmatic, Congenital; Retrospective Studies; Case-Control Studies; Enteral Nutrition; Parenteral Nutrition
PubMed: 37507336
DOI: 10.1016/j.jpedsurg.2023.06.018 -
The Cochrane Database of Systematic... Aug 2021Gastro-oesophageal reflux disease is a particularly common condition among preterm and low birth weight infants. These infants are more likely to have excessive... (Review)
Review
BACKGROUND
Gastro-oesophageal reflux disease is a particularly common condition among preterm and low birth weight infants. These infants are more likely to have excessive regurgitation, as they do not have a fully developed antireflux mechanism. Preterm and low birth weight infants who are unable to suck oral feeds are required to be fed via an intragastric tube for varying lengths of time. Intragastric tube feeding can be delivered by the intermittent bolus method or by the continuous feeding method. Use of continuous or intermittent bolus intragastric feeding may have a positive or negative effect on the incidence or severity of gastro-oesophageal reflux disease.
OBJECTIVES
• To determine whether continuous or intermittent bolus intragastric tube feeding reduces the number of episodes and the duration of gastro-oesophageal reflux disease (GORD) in preterm and low birth weight infants • To perform subgroup analyses for gestational age; birth weight; age in days from birth at full enteral feeding via intragastric tube (breast versus bottle); frequency of intermittent bolus feed; and type of medication for treatment of GORD (only if medication was prescribed and was given similarly to both intervention groups) SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 7), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), on 8 July 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs.
SELECTION CRITERIA
Published and unpublished RCTs and quasi-RCTs were eligible for inclusion in this review, as were cluster-randomised and cross-over randomised trials that compared the effects of continuous versus intermittent bolus intragastric tube feeding on gastro-oesophageal reflux disease in preterm and low birth weight infants.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed study eligibility and quality. We planned to use the GRADE approach to assess the certainty of evidence.
MAIN RESULTS
We found no trials that met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS
We did not identify any randomised trials that evaluated the effects of continuous versus intermittent bolus intragastric tube feeding on gastro-oesophageal reflux disease in preterm and low birth weight infants. Well-designed and adequately powered trials are needed.
Topics: Birth Weight; Enteral Nutrition; Gastroesophageal Reflux; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Intubation, Gastrointestinal
PubMed: 34355390
DOI: 10.1002/14651858.CD009719.pub3 -
European Review For Medical and... Jun 2022Enteral nutrition (EN) is the first-choice nutritional support, as it is more in line with normal physiological processes. During EN, the major goals to achieve include... (Review)
Review
OBJECTIVE
Enteral nutrition (EN) is the first-choice nutritional support, as it is more in line with normal physiological processes. During EN, the major goals to achieve include accurate confirmation of the feeding tube position, monitoring the gastric residual volume, assessing gastrointestinal motility, and monitoring the nutritional status of patients. With rapid development in technology, point-of-care ultrasound (POCUS) has become a more convenient and effective technical tool for monitoring critically ill patients receiving EN. In this review, we have summarized and discussed the value of POCUS in the implementation, monitoring, and evaluation of EN therapy to provide a reference for nutritional support of critically ill patients in critical care settings.
MATERIALS AND METHODS
This is a narrative review. A literature search for Scopus-indexed articles was performed randomly using PubMed and MEDLINE databases as the primary sources. No specific term was used for the search.
RESULTS
POCUS can be used for positioning of nasogastric and nasointestinal tubes, evaluation of gastric residuals and gastrointestinal motility as well as monitoring of nutritional status.
CONCLUSIONS
POCUS is a real-time, highly repeatable, radiation-free, and non-invasive visual inspection technique, with high application value in assessing the nutritional status of patients receiving EN and guiding the development of further nutritional treatment plans. It is an important diagnostic and monitoring tool that can be used by the clinicians in the ICU.
Topics: Critical Care; Critical Illness; Enteral Nutrition; Humans; Intensive Care Units; Intubation, Gastrointestinal; Point-of-Care Systems
PubMed: 35731061
DOI: 10.26355/eurrev_202206_28960 -
Trials Apr 2023The Taste And Smell To Enhance nutrition (TASTE) trial investigated the effects of smell and taste of milk with tube feeding compared to routine care on the growth of...
BACKGROUND
The Taste And Smell To Enhance nutrition (TASTE) trial investigated the effects of smell and taste of milk with tube feeding compared to routine care on the growth of preterm infants. There was no difference between groups in growth (weight, head circumference, length) z-scores at discharge from the hospital. Infants in the intervention group had higher head circumference and length z-scores at 36 weeks postmenstrual age, both secondary outcomes. The objective of this follow-up study is to assess 2-year neurodevelopmental and growth outcomes after exposure of preterm infants to the smell and taste of milk with tube feeding compared to routine care.
METHODS
This is a neurodevelopmental follow-up study of a two-center, placebo-controlled randomized trial. Infants born before 29 weeks postmenstrual age and/or with a birth weight of less than 1250 g were randomized to smell and taste of milk with each tube feed or routine care. The current follow-up assessed the 2-year neurodevelopmental and growth outcomes of participants of the TASTE trial discharged from the hospital (n = 334). The primary outcome is survival free of any major neurodevelopmental impairment comprising any moderate/severe cerebral palsy (Gross Motor Function Classification System score II-V), Bayley Scales of Infant and Toddler Development, Third/Fourth Edition (Bayley-III/Bayley-4) motor, cognitive, or language scores < -2SD, blindness, or deafness at 2 years of age. Other outcomes include death, breastfeeding within the first year, and respiratory support, oral feeding, and anthropometric parameters at 2 years of age. The Human Research Ethics Committees of Mater Misericordiae Limited and the Royal Women's Hospital approved the TASTE trial including the neurodevelopmental follow-up described in this protocol.
DISCUSSION
For patients and their families, the neurodevelopmental outcomes of preterm infants are of utmost importance. Consequently, they should be investigated following any interventional study performed during the newborn period. Furthermore, improved weight gain and head growth in the hospital are associated with better long-term neurodevelopmental outcomes. Smelling and tasting of milk is an uncomplicated and cost-effective intervention that may improve the growth and neurodevelopmental outcomes of preterm infants. Potential limitations affecting this follow-up study, caused by the COVID-19 pandemic, are anticipated and discussed in this protocol.
TRIAL REGISTRATION
Name of the registry: Australian and New Zealand Clinical Trials Registry; Registration number: ACTRN12617000583347 ; Registration date: 26 April 2017.
Topics: Infant; Infant, Newborn; Humans; Female; Infant, Premature; Follow-Up Studies; Enteral Nutrition; Milk, Human; Taste; Smell; Pandemics; Australia; COVID-19; Randomized Controlled Trials as Topic
PubMed: 37085869
DOI: 10.1186/s13063-023-07224-0 -
Digestive Diseases (Basel, Switzerland) 2016Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the... (Review)
Review
Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017.
Topics: Adult; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Endoscopy; Enteral Nutrition; Female; Humans; Male; Pancreatitis; Pancreatitis, Acute Necrotizing; Prognosis; Randomized Controlled Trials as Topic
PubMed: 27336312
DOI: 10.1159/000445257