Factors related to swallowing recovery for nil per os patients after stroke and prediction model / 中国康复理论与实践

@#Objective To explore the factors related to the recovery of nil per os (NPO) patients after stroke by retrospective data analysis, and to establish a predictive model.Methods The information of demographics, evaluation and treatment of 141 stroke patients admitted to the Hearing and Language Department in Beijing Bo'ai Hospital from April, 2017 to November, 2020 were selected. The predictive model was established by univariate analysis and Logistic regression. The fitting degree and discriminant validity of the model were evaluated by Hosmer-Lemeshow (H-L) test and receiver operating characteristic (ROC) curve. Other 121 patients with post-stroke dysphagia from December, 2020 to November, 2021 were used as the validation set to verify the model.Results For univariate analysis, National Institute of Health Stroke Scale (NIHSS) score, drinking water test results, autonomous cough ability, cough after swallowing, movement ability of tongue and jaw, and electrical stimulation treatment were significantly associated with the outcome (H=65.803, χ2 > 4.623, P<0.05). Multivariate Logistic regression analysis showed that NIHSS score (X1, OR=0.772, 95%CI 0.64 to 0.82, P<0.001), spontaneous cough ability (X2, OR=5.116, 95%CI 1.28 to 20.41, P=0.021), and electrical stimulation during treatment (X3, OR=94.718, 95%CI 5.65 to 1589.26, P=0.002) were independent factors for the outcome of swallowing function. Thus, the predictive model was P=11+e−(2.368−0.325X1+1.632X2+4.551X3) P = 1 1 + e - ( 2.368 - 0.325 X 1 + 1.632 X 2 + 4.551 X 3 ) , which was well fitting (P=0.845), with the largest area under curve (0.884). The overall accuracy of the model in the validation set was 91.7%.Conclusion The patients with dysphagia would like to recover well if he/she was with lower NIHSS scores and normal autonomous cough ability; meanwhile, the addition of electrical stimulation therapy in comprehensive rehabilitation may be helpful. A predictive model has been established, which needs a further research.

Respiratory pattern intervention can quickly improve the oral feeding of pre-term infants with suck-swallow-breath coordination disorder / 中华物理医学与康复杂志

Objective:To investigate the effect of a breathing pattern intervention (RPI) on the oral feeding of pre-term infants with suck-swallow-breath (SSwB) coordination disorder.Methods:Sixty pre-term infants with SSwB coordination disorder were divided into an observation group ( n=30) and a control group ( n=30) using a random number table. Both groups were given routine feeding training, including oral exercise intervention, non-nutritive sucking training, and swallowing induction training during nursing, while the observation group was additionally provided with 15 minutes of breathing pattern training once a day, including breathing pattern observation, resistive breathing training prior to eating and passive breathing pattern intervention during eating. Before and after the 7-day intervention, the Pre-term Infant Oral Feeding Readiness Assessment (PIOFRA) was used to evaluate each subject′s oral feeding ability. Rate of transfer (RT), proficiency (PRO), minimum oxygen partial pressure (SaO 2) and SaO 2 fluctuations were also recorded during the feeding process. Results:After 1 week of the intervention, significant improvement was observed in both groups. In the observation group the average RT (2.76±0.36ml/min), PRO, minimum SaO 2, the number of SaO 2 fluctuations, and PIOFRA score (33.28±0.58) were all significantly better than the control group′s averages. Conclusion:Breathing pattern intervention based on routine feeding training can enhance breathing coordination during swallowing and ultimately improve the oral feeding of pre-term infants with SSwB coordination disorders in a relatively short period of time.

Effect of nutritional status and comfortability of early postoperative diet of patients following sedated colonoscopic polypectomy / 中国实用护理杂志

Objective:To investigate the effect of nutritional status and comfortability of early postoperative diet of patients following sedated colonoscopic polypectomy.Methods:A total of 300 patients who undergoing sedated colonoscopic polypectomy were randomly divided into normal group and experimental group 1, group 2, with 100 cases in each group. The control group received total fasting with intravenous infusion, oral clear fluids were begun up on the first postoperative day and solid foods on the fourth day. In the experimental group 1 and group 2, clear fluids were begun up to six hours or two hours after surgery, respectively, followed by semi-liquid on the first postoperative day, and solid food three days later. The clinical outcomes such as time of first defecation, hospitalization time, abdominal pain, hypoglycemial reaction, bleeding volume and nausea/vomiting was recorded between three groups. In addition, the nutritional status and comfortability was compared by using serum albumin detection and Visual Analogue Scale (VAS), respectively.Results:The time of first defecation were (22.46±2.96) hours and (21.54±2.17) hours in the experimental group 1 and group 2, significantly shorter than that in the control group (26.37±4.87) hours; meanwhile, the time of first defecation were significantly decreased in the experimental group 2 compared to the experimental group 1, the difference was statistically significant ( F value was 51.812, P<0.05). The rate of hypoglycemial reaction were 5.10% (5/98) and 2.04% (2/98) in the experimental group 1 and group 2, significantly lower than that in the control group 13.40% (13/97), the difference was statistically significant ( χ2 value was 10.582, P<0.05). After 5th day of surgery, the level of serum albumin were (36.16±6.44) g/L and (36.55±6.57) g/L in the experimental group 1 and group 2, significantly higher than those in the control group (33.97±5.91) g/L, the difference was statistically significant ( F value was 4.732, P<0.05). However, there was no significant difference in the VAS scores among the three groups ( P>0.05). Conclusion:Two hours after sedated colonoscopic polypectomy oral feeding can obviously promote the recovery of gastrointestinal function, which does not increase the occurrence of postoperative complications, and promote the postoperative recovery of the patients.

Influencing factors associated with transition time to achieve full oral feeding for premature infants in neonatal intensive care unit / 中国实用护理杂志

Objective@#To investigate and analyze the influencing factors associated with transition time to achieve full oral feeding for premature infants in neonatal intensive care unit (NICU).@*Methods@#A total of 251 NICU hospitalization preterm infants and their mothers meeting the inclusion criteria in Shanghai First Maternal and Infant Health Care Hospital were collected. Finding the medical records to obtain the basic information of the premature infants and feeding conditions, the Self-rating Anxiety Scale (SAS) and the Beck Depression Scale-Ⅱ(BDI- Ⅱ) was used to assess the mothers′ anxiety and depression.@*Results@#The transition time to achieve full oral feeding of NICU preterm infants was (5.31±2.93) days. Greater gestational age (β=-0.484, P<0.01), time of breast milk feeding through mouth (β=0.042, P=0.003) had a positive effect on the transition time to achieve full oral feeding. Congenital heart disease (β=0.587, P=0.050), maternal anxiety (β=0.206, P<0.01), depression (β=0.727, P<0.01) and interaction between maternal anxiety and depression (β=0.014, P<0.01) were risk factors of longer time to achieving full oral feeding. The multiple linear regression accounting for a total of 58.2% of all the variation.@*Conclusions@#Oral feeding progression in premature infants was influenced by many factors. Gestational age can be the indicators of implementing oral feeding. It is beneficial to initiate oral feeding and feed with breast milk early. If the infants have heart diseases, oral feeding progression would be retardant. Maternal anxiety and depression may prolong the transition time to achieve full oral feeding. Control the factors which affect oral feeding progression, pay attention on mothers′ emotion and formulate appropriate feeding intervention for premature infants to promote full oral feeding are of great importance.

Normalización escala Early Feeding Skills (EFS) en recién nacidos prematuros / Standardization of Early Feeding Skills (EFS) scale in preterm infants

INTRODUCCIÓN: La escala Early Feeding Skills (EFS) evalúa la conducta del neonato antes, durante y posterior al proceso de alimentación. OBJETIVOS: Determinar la validez de fachada, de contenido y evaluar con dicha escala el proceso de alimentación en los recién nacidos prematuros comparando con variables relevantes. PPACIENTES Y MÉTODO: Se evaluaron prematuros de 34 a 36 semanas de edad corregida sin daño neurológico o malformaciones craneofaciales. Diseño de tipo descriptivo de corte transversal. Los datos fueron obtenidos mediante escala EFS, versión corregida mediante validación de fachada y contenido. Las variables de estudio fueron género, logro de alimentación por pecho, y habilidades de alimentación durante el proceso de alimentación, evaluadas por 2 observadoras Se analizaron medidas de dispersión y se aplicó prueba Fisher al 5% de significancia, estableciendo la asociación de los resultados obtenidos con las variables. RESULTADOS: Se evaluaron 5 dominios: (1) Capacidad de mantenerse enfocado en la alimentación, en que el 75,3% posee un nivel desempeño deficiente y el 28,6% equitativo existiendo diferencias significativas con la variable sexo. (2) Capacidad de organizar el funcionamiento motor - oral tiene un 10,5% deficiente, un 68,8% equitativo y un 20,6% bueno. (3) Capacidad de coordinar la deglución el 95,2% presenta un rendimiento equitativo. (4) Capacidad de mantener la estabilidad fisiológica el 96,7% fue equitativo y en (5) Evaluación de la tolerancia alimentaria oral tiene un desempeño deficiente del 41,6%. CONCLUSIÓN: La escala EFS es una herra mienta que aporta información relevante para describir el proceso de alimentación oral en lactantes prematuros, permitiendo identificar las áreas de mayor dificultad que requieren tratamiento profe sional, sin embargo, esta herramienta no es suficiente por sí sola para llevar a cabo una evaluación integral del proceso de alimentación del neonato.

INTRODUCTION: The Early Feeding Skills (EFS) scale assessed the neonate's behavior before, during, and after the feeding process. OBJECTIVES: To determine the face and content validity, and to evaluate with this scale the feeding process in premature newborns comparing with relevant variables. PATIENTS AND METHOD: Premature newborns were evaluated; they were between 34 to 36 weeks of corrected age, without neurological damage or craniofacial malformations. Cross-sectional descriptive study. The data were obtained through the EFS scale, version corrected by face and content validation. The study variables were gender, breastfeeding achievement, and feeding skills during the feeding process, evaluated by two observers. Dispersion measures were analyzed, and the Fisher test was used at 5% significance, establishing the association of the obtained results with the variables. RESULTS: 5 domains were evaluated: (1) Ability to stay focused on food, in which 75.3% have a poor performance level, and 28.6% equitable, with significant differences in the sex variable. (2) Ability to organize motor- oral functioning presents 10.5% deficient, 68.8% equitable, and 20.6% good. (3) Ability to coordinate swallowing 95.2% presents an equitable performance. (4) Ability to maintain physiological stability 96.7% was equitable; and (5) Evaluation of oral food tolerance presents 41.6% of poor performance. CONCLUSION: The EFS scale is a tool that provides relevant information to describe the oral feeding process in premature infants, allowing to identify the areas of greatest difficulty that require profes sional treatment, however, this tool is not enough by itself to carry a comprehensive evaluation of the newborn feeding process.

An analysis of the items of nursing competency in oral feeding assistance for hospitalized hemiplegic patients in China: a qualitative study

Background: Patients with hemiplegia often suffer from malnutrition and security threat due to disabilities and inadequate supports. This study aims to explore nursing perceptions regarding problems, necessary nursing supports, and nursing competencies required for the provision of oral feeding assistance to hospitalized hemiplegic patients.Methods: A qualitative study was conducted in Taian City, China in 2016. A purposive sampling method was used, and data were gathered using semi-structured interviews. Totally, 5 faculty members and 10 ward nurses in China were interviewed. In relation to the nursing status regarding oral feeding assistance in the case of hemiplegic patients, background and improvement measures in nursing practice were assessed. Data were analyzed using the content analysis method.Results: Four problems in providing oral feeding assistance to hemiplegic patients were identified: 1) insufficient cognition of nursing roles, 2) insufficient consideration of psychological aspects of the patients, 3) lack of related theoretical and practical education, 4) lack of nutritional support during hospitalization. Twenty-five items of nursing competencies, the knowledge and skills required for oral feeding assistance to hospitalized hemiplegic patients were identified.Conclusions: The nursing competency identified by this study can provide evidence for reviewing the related nursing practice and continuous education in China.

Research advances in assessment tools for oral feeding readiness in preterm infants / 中国实用护理杂志

In recent years, the oral feeding readiness for preterm infants has been paid more and more attention, and there are various assessment tools for the oral feeding readiness. The professionals in various countries have been constantly improved and adjusted according to the national and clinical conditions, but up to now, no unified standard has been formed. This paper reviews the assessment tools of preterm infant′s oral feeding readiness at home and abroad, and provides reference for the unified evaluation standard of preterm infant's oral feeding readiness, so as to establish more standardized and effective intervention strategies and enhance the effect of preterm infant′s oral feeding nursing.

Learning curve of non-tube and early oral feeding after McKeown minimally invasive esophagectomy / 中国胸心血管外科临床杂志

@#Objective    To investigate the learning curve of non-tube and early oral feeding procedure following McKeown minimally invasive esophagectomy (MIE). Methods    We analyzed the clinical data of 38 patients (26 males, 12 females, aged 42–79 years) with esophageal cancer who received non-tube and early oral feeding procedure after surgery at the Affiliated Tumor Hospital, Zhengzhou University from November 2017 to August 2018. They suffered upper thoracic esophageal cancer (n=4), middle thoracic esophageal cancer (n=22) or lower thoracic esophageal cancer (n=12). Results    McKeown MIE was successfully performed on 38 patients. Oral feeding began 1.7 (1-4) days after surgery in the 38 patients with non-tube. Pneumonia/atelectasis occurred in 5 patients (13.1%), respiratory failure in 1 patient (2.6%), arrhythmia in 3 patients (7.9%), hoarseness in 5 patients (13.1%), anastomotic fistula in 1 patient (2.6%), cervical incision infection in 1 patient (2.6%), pneumomediastinum and infection in 1 patient (2.6%) and gastric emptying disorder in 2 patients (5.2%). No death was observed. After 26 patients with McKeown MIE were treated with enhanced recovery after surgery procedure, the operation time and complications could reach a relatively stable state and entered a plateau phase of learning curve. Conclusion    Non-tube and early oral feeding procedure following MIE is technically safe and feasible. It can shorten hospital stay, relieve the discomfort of placement of nasogastric and nutrition tube and may reduce the incidence of complications. The learning curve of non-tube and early oral feeding procedure following MIE is  about 26 cases.

The evaluation of oral feeding ability in preterm infants / 中国新生儿科杂志

Objective To study the efficacy of the preterm oral feeding assessment scale (POFAS) in evaluating oral feeding capacity in preterm infants of different gestational age.Method Revised POFAS including the preterm oral feeding readiness assessment scale and sucking ability scale was used to dynamically evaluate the oral feeding capacity of the stable preterm infants with corrected gestational age (CGA) ≥32+4 weeks.The ratio of actual oral intake volume to planned feeding volume (A/P) was measured,and the correlation of the POFAS score and A/P ratio was studied using Pearson correlation analysis.The risk factors of the A/P ratio was studied using Logistic regression analysis.The receiveroperating characteristic (ROC) curve was drawn to explore the predictive value of POFAS score for A/P ratio reaching 50％.Result A total of 44 infants (59.1％ male) with 158 times of evaluation were enrolled in the study.The gestational age was (30.9±2.1) weeks,and the birth weight was (1 543±478)g.The enteral feeding was started at (31.1 ± 2.0)weeks of CGA,the oral feeding at (33.7 ± 1.4) weeks,and complete oral feeding at (34.9± 1.3) weeks.When reaching the same CGA,infants born at earlier gestational age had a smaller A/P ratio.Pearson correlation analysis showed that with CGA＞33 weeks,all the indicators can predict the feeding conditions of the infants,the POFAS score was positively correlated with the A/P ratio (P＜0.05).The ROC for the POFAS score to predict a 50％ A/P ratio was 0.951 (P＜0.05),and the cut-off value was 6.5 (sensitivity 93.8％,specificity 83.3％).The POFAS score and sucking ability score were the risk factors of a 50％ A/P ratio in preterm infants with 34 weeks CGA.Conclusion Revised POFAS can be effectively used to assess preterm infants' oral feeding ability,promote oral feeding and early discharge from the hospital.

Application value of enhanced recovery after surgery in minimally invasive radical resection of esophageal cancer / 中华消化外科杂志

Objective To investigate the application value of enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding in minimally invasive radical resectionof esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 126 patients who underwent minimally invasive McKeown surgery in the General Hospital of Southern Theatre Command of PLA between March 2016 and October 2017 were collected.There were 80 males and 46 females,aged from 52 to 82 years,with an average age of 64 years.Of 126 patients,82 undergoing "li's anastomosis" with no gastrointestinal decompression tube and receiving early postoperative oral feeding were allocated into non-tube no fasting group,and 44 undergoing end-to-side gastroesophageal anastomosis with tubular stapler,conventionally indwelling gastrointestinal decompression tube,and beginning oral feeding at 1 week after surgery were allocated into traditional treatment group.Observation indicators:(1) surgical and postoperative recovery situations;(2) results of pathological examination;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence and metastasis up to October 2018.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was analyzed using independent sample t test.Measurement data with skewed distribution were expressed as M (range),and comparison between groups was analyzed by rank sum test.Count data were described as absolute number or percentage,and comparison between groups was analyzed using chi-square test.Ordinal data were analyzed by rank sum test.Results (1) Surgical and postoperative recovery situations:patients in the two groups underwent minimally invasive McKeown surgery successfully.Operation time,volume of intraoperative blood loss,incidence of anastomotic fistula,incidence of pulmonary complications,and duration of postoperative hospital stay were respectively (326±41) minutes,(225±96) ml,7.3 ％ (6/82),24.4％ (20/82),and 10 days (range,6-90 days) in the non-tube no fasting group and (317± 37) minutes,(214 ± 66) mL,9.1％ (4/44),20.5％ (9/44),and 14 days (range,10-42 days) in the traditional treatment group;there was a statistically significant difference in duration of postoperative hospital stay between the two groups (Z =-7.129,P ＜ 0.05) and no statistically significant difference in operation time,volume of intraoperative blood loss,incidence of anastomotic fistula,and incidence of pulmonary complications between the two groups (t =1.311,0.703,x2 =0.000,0.077,P＞0.05).(2) Results of pathological examination:the number of lymph node dissected,cases in postoperative TNM stage Ⅰ,Ⅱ and Ⅲ were respectively 27±5,12,55,15 in the non-tube no fasting group and 26±5,9,28,7 in the traditional treatment group,with no statistically significant difference between the two groups (t =0.549,Z =-0.747,P＞0.05).(3) Follow-up:of 126 patients,116 were followed up for 12-31 months,with a median time of 20 months,including 76 in the non-tube no fasting group and 40 in the traditional treatment group.During the follow-up,no tumor recurrence or metastasis was found in the 116 patients.Conclusion The enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding is safe and feasible in the McKeown surgery,which can significantly shorten the postoperative hospitalization time compared with the traditional treatment.

Research advances in assessment tools for oral feeding readiness in preterm infants / 中国实用护理杂志

In recent years, the oral feeding readiness for preterm infants has been paid more and more attention, and there are various assessment tools for the oral feeding readiness. The professionals in various countries have been constantly improved and adjusted according to the national and clinical conditions, but up to now, no unified standard has been formed. This paper reviews the assessment tools of preterm infant′s oral feeding readiness at home and abroad, and provides reference for the unified evaluation standard of preterm infant's oral feeding readiness, so as to establish more standardized and effective intervention strategies and enhance the effect of preterm infant′s oral feeding nursing.

Effect of breathing exercises on improving oral feeding ability of premature infants / 中国实用护理杂志

Objective To investigate the effects of respiratory training on oral feeding ability, feeding response, transition time, hospitalization time, gastric tube indwelling time and recovery time to birth weight in premature infants. Methods The Neonatal Intensive Care Unit(NICU) preterm infants who were in accordance with the inclusion criteria were divided into the observation group and the control group according to the random number method. The observation group was 20 cases, the control group was 21 cases. The control group implemented NICU routine nursing, including oral nursing, umbilical nursing, body position nursing. The observation group received respiratory training exercises on the basis of the control group, and the oral feeding ability of the two groups of premature infants was evaluated and recorded after intervention at the beginning of 0, 5, 10, 15 d.The feeding reaction, transition time, the hospitalization time and gastric tube indwelling time were recorded in two groups of preterm infants. Results The non-nutritive sucking scores after intervention at the beginning of 0, 5, 10, 15 d were (31.10±5.57), (37.50±4.86), (53.20±7.60), (74.90±4.77) points in the observation group . The non-nutritive sucking scores after intervention at the beginning of 0, 5, 10, 15 d were (31.91±5.56), (33.36±6.17), (45.54±5.39), (62.82±6.78) points in the control group. There was no significant difference after intervention at the beginning of 0, 5 d between the two groups (t=-0.333,1.694, all P>0.05), but had the significant difference after intervention at the beginning of 10 ,15 d (t=2.683, 4.676, all P <0.05). The transition time,gastric tube indwelling time and recovery time to birth weight in premature infants was (7.15±1.72), (11.00±2.37), (7.86±1.43) d in the observation group and (10.33±2.44), (16.14±2.29), (9.97±1.69) d in the control group, and there were significant differences between the two groups(t=-4.807, 3.335,-9.905, P <0.05 ). There was no significant difference in the hospitalization time between the two groups(P>0.05). Conclusions Breathing exercises can improve the oral feeding ability and improve the feeding effect of premature infants.

Investigation and analysis of influencing factors of oral feeding progression in very-low-birth-weight infants / 中国实用护理杂志

Objective To investigate oral feeding progression and its influencing factors in very-low-birth-weight infants. Methods Investigation was conducted among 114 infants with the Gestational age≤30 weeks,birth weight≤1 500 g using very low birth weight infants clinical information questionnaire and oral feeding survey. Results The very low birth weight infants started enteral nutrition(20.61±4.67) h after admission, achieved a total enteral nutrition (41.47 ± 15.53) days after birth with the correct gestational age was (34.35 ± 2.76) weeks. The infants started oral feeding (41.47 ± 15.53) days after birth with the correct gestational age(34.58±1.98)weeks.The infants achieved full oral feeding(55.19±16.30) days after birth with the correct gestational age(36.40 ±1.99)weeks.Single factor and multiple regression analysis showed that birth weight,gestational age,BPD were significant factors of oral feeding progression. Conclusions The smaller gestational age, birth weight, the longer duration the infants reach the oral feeding milestones, Infants with BPD have obvious oral feeding progression. The medical staffs should learn that the very low birth weight have oral feeding difficulties and thus take positive and effective measures to promote the advancement of oral feeding.

Study on feeding support and the cause of stopping oral feeding in premature infants / 中国实用护理杂志

Objective To investigate the use of feeding support and influencing factors of oral feeding among premature infants. Methods Totally 103 premature infants with oral feeding problems hospitalized during June to December 2014 were enrolled. The postmenstrual age and feeding support were observed at the time of initiation oral feeding and full oral feeding. Moreover, the progress and performance of oral feeding, the daily increase in weight, the time of body weight regain, the time of assisted ventilation and length of hospital stay and so on were calculated. Results There were 96 premature infants using feeding support at the time of initiation oral feeding and 58 premature infants at the time of full oral feeding. Logistic regression analysis showed that birth gestational age(OR=2.195, P<0.01), birth weight(OR=1.003, P<0.01), severity of illness(OR=0.121, P<0.01) and feeding tolerance(OR=0.007, P<0.01)were important factors of oral feeding among premature infants. Conclusions The premature infants with small gestational age at birth, low birth weight, severity of illness, and feeding intolerance are high risk populations of oral feeding. Nurses should take timely risk assessment and interventions to reduce the occurrence of stopping oral feeding.

Influence of early oral feeding after laparoscopic surgery in functional status and gastrointestinal living quality of patients with colorectal cancer / 吉林大学学报(医学版)

Objective To investigate the influence of early oral feeding (EOF)after laparoscopic surgery in the function status and gastrointestinal living quality of the patients with colorectal cancer,and to clarify the feasibility of EOF after laparoscopic surgery.Methods Sixty-three patients underwent laparoscopic surgery of colorectal cancers participated in the trial.Of these,31 patients received EOF as EOF group,received a clear liquid diet on the first postoperative day followed by a regular diet as tolerated;the other 32 patients received traditional oral feeding (TOF ) as TOF group who were fed with feeding only after the recovery of their postoperative gastrointestinal functions. The nasogastric tube was removed from all patients in both groups immediately after surgery.Self-designed EOF questionnaire data, Karnofsky Scores and Gastrointestinal Quality of Life Index (GIQLI)Scores were used to evaluate the functional status and gastrointestinal living guality of the patients. Results The using time of total parenteral nutrition (TPN),time of postoperative hospital stay,and costs after surgery in EOF group were lower than those in TOF group (P0.05),and the incidence of abdominal distension was higher than that in TOF group (P<0.05);on postoperative day 7,the albumin recovered faster in EOF group (P<0.05),and on postoperative day 4 and 7,the pro-albumin also recovered faster in EOF group (P<0.05);the patients in EOF group had a higher Karnofsky score (P<0.05)and GIQLI score compared with the patients in TOF group (P<0.05 ). Conclusion EOF after laparoscopic surgery in the patients with colorectal cancers is beneficial for rehabilitation,and it can reduce the risk of hospitalization and saving its costs;it plays an active role in protein recovery,and improves the functional status and gastrointestinal living quality of the patients.

Effect of oral stimulation on oral feeding ability of preterm infants / 中华实用儿科临床杂志

Objective To study the effect of Sandra Fucile oral stimulation on oral feeding readiness and ability of preterm infants.Methods Sixty-five premature infants were selected in the study.All of the premature infants were recruited randomly in convenience between Jul.and Dec.2012.For a randomized control principle,SPSS 13.0 was performed to achieve complete random design.Objects were divided into control group(receiving routine nursing) and intervention group(on the basis of routine nursing,receiving 15 minutes oral stimulation,1 time/day,for 10 days).Chinese version of Preterm Infant Oral Feeding Readiness Assessment scale(PIOFRA scale-CV) was used when intervention began,and 7 days,10 days,14 days after the start of the intervention.Results PIOFRA-CV scale score was statistically different at different time in both groups(F =169.062,P ＜0.001).The first day ratings were minimum in the 2 groups,after which with an upward trend over time.The control group and intervention group rated a statistically significant difference(F =5.538,P =0.022).Except for no difference on the first day and seventh day (t =1.650,P =0.204 ;t =0.817,P =0.369) between the 2 groups,the intervention group had a higher score than the control group (t =17.339,24.141,all P ＜0.001).Group and time had an interaction effect(F =1 1.561,P ＜0.001).The incidence of vomiting[42.4％ (14/33 cases) vs 34.4％ (11/32 cases)],infection [27.3％ (9/33 cases) vs 9.4％ (3/32 cases)],and gastro-oesophageal reflux[30.3％ (10/33 cases) vs 25.0％ (8/32 cases)] were not significantly different between the 2 groups(x2 =0.445,3.457,0.288,all P ＞ 0.05).Conclusions Saudra Fucile oral stimulation method can significantly promote the development of premature oral feeding ability on the 10 day after the intervention,and will not increase vomiting,gastroesophageal reflux,and infection.It is suitable for clinical application.

Clinical feasibility and nutritional effects of early oral feeding after pancreaticoduodenectomy

BACKGROUNDS/AIMS: Pancreaticoduodenctomy (PD) is associated with high rates of postoperative morbidity and mortality. Although many studies have shown that early postoperative enteral nutrition improves postoperative outcomes, limited clinical information is available on postoperative early oral feeding (EOF) after PD. The aim of this study was to evaluate the clinical feasibility, safety, and nutritional effects of EOF after PD. METHODS: Clinical outcomes were investigated in 131 patients who underwent PD between 2003 and 2013, including 81 whose oral feeding was commenced within 48 hours (EOF group) and 50 whose oral feeding was commenced after resumption of bowel movements (traditional oral feeding [TOF] group). Postoperative complications, energy intake, and length of stay (LOS) were reviewed. RESULTS: Demographic factors were similar in the two groups. The EOF group had a significantly shorter LOS (25.9+/-8.5 days vs. 32.3+/-16.3 days; p=0.01) than the TOF group. The rates of anastomotic leak (1.2% vs. 16%, p=0.00) and reoperation (3.7% vs. 20%, p=0.01) were significantly lower in the EOF group. In the clinically acute phase from postoperative day 1 to day 5, the mean daily calorie intake (847.0 kcal vs. 745.6 kcal; p=0.04) and mean daily protein intake (42.2 g vs. 31.9 g; p=0.00) in the EOF group were significantly higher than that in the TOF group. CONCLUSIONS: Postoperative EOF is a clinically safe, feasible, and effective method of nutritional support after PD.

Fatores de risco para raquianestesia em recém-nascidos pré-termo submetidos a herniorrafia inguinal / Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair

OBJETIVOS: Investigar os fatores de risco e a incidência de efeitos adversos perioperatórios advindos da raquianestesia não suplementada em recém-nascidos pré-termo. Também foi avaliado o tempo decorrido até o reinício da alimentação oral e até a alta hospitalar. MÉTODOS: Foram coletados prospectivamente os dados perioperatórios de todos os recém-nascidos prematuros e ex-prematuros submetidos a herniorrafia inguinal com raquianestesia em um centro médico terciário. RESULTADOS: O grupo de estudo consistiu em 144 recém-nascidos com uma idade gestacional mediana de 30 semanas, idade concepcional de 37 semanas, peso de nascimento de 1.420 g, e peso de 2.140 g no momento da cirurgia. No total, seis (4,2%) recém-nascidos apresentaram complicações intraoperatórias, que incluíram apneia (2/1,4%), bradicardia (2/1,4%) e hipoxemia (4/2,8%). Complicações pós-operatórias ocorreram em 15 (10,4%) recém-nascidos, principalmente hipoxemia (3/2,1%), bradicardia (8/5,5%) e apneia (6/4,1%). Os fatores preditivos de desfecho desfavorável (apneia, alimentação oral > 6 h de pós-operatório, ou alta > 30 h de pós-operatório) foram displasia broncopulmonar [razão de chances (OR) = 3,2, intervalo de confiança de 95% (IC95%) 2,8-5,3; p = 0,01] e leucomalácia periventricular (OR = 2,8, IC95% 2,1-4,9; p = 0,03). CONCLUSÕES: A raquianestesia é segura e eficaz na herniorrafia inguinal em recém-nascidos pré-termo, levando a um reinício precoce da alimentação oral e a um menor período de hospitalização. Displasia broncopulmonar e leucomalácia periventricular podem acarretar risco de desfecho desfavorável.

OBJECTIVES: To investigate the risk factors and incidence of perioperative adverse effects from unsupplemented spinal anesthesia in preterm infants. Times to resumption of oral feeding and to home discharge were also evaluated. METHODS: Perioperative data were collected prospectively for all preterm and former preterm infants who underwent inguinal hernia repair with spinal anesthesia at a tertiary medical center. RESULTS: The study group consisted of 144 infants with a median gestational age of 30 weeks, postmenstrual age of 37 weeks, birth weight of 1,420 g, and weight at surgery of 2,140 g. Overall, six (4.2%) infants had intraoperative complications, which included apnea (2/1.4%), bradycardia (2/1.4%), and hypoxemia (4/2.8%). Postoperative complications occurred in 15 (10.4%) infants, mainly hypoxemia (3/2.1%), bradycardia (8/5.5%), and apnea (6/4.1%). Predictive factors of an unfavorable outcome (apnea, resumption of oral feeding > 6 h postoperatively, or discharge > 30 h postoperatively) were bronchopulmonary dysplasia (odds ratio [OR] = 3.2, 95% confidence interval [95%CI] 2.8-5.3; p = 0.01) and periventricular leukomalacia (OR = 2.8, 95%CI 2.1-4.9; p = 0.03). CONCLUSIONS: Spinal anesthesia is safe and effective for inguinal hernia repair in preterm infants, with early resumption of oral feeding and short hospitalization. Bronchopulmonary dysplasia and periventricular leukomalacia may pose risks for an unfavorable outcome.

Perinatal Outcomes of Preterm Twins <34 Weeks after IVF Pregnancies versus Natural Conception: Same Oral Feeding Tolerance?

PURPOSE: To compare the oral feeding tolerance that reflects a general maturity of organization of behavior and response among preterm twins less than 34 weeks of gestation conceived after in vitro fertilization with/without embryo transfer (IVF-ET) with that of natural conception. METHODS: Medical records of 135 preterm twins less than 34 weeks of gestation (74 twins conceived after IVF-ET and 61 spontaneously conceived twins) admitted to the Neonatal Intensive Care Unit (NICU) of Dong-A Medical Center during the period from January 2003 to December 2010 were used for a retrospective study. The primary study outcomes were perinatal mortality and overall short term morbidity. The secondary study outcome was oral feeding tolerance. RESULTS: There was no difference among the two groups in the gestational age and birth weight. Perinatal mortality rate and morbidity rate was not different between the two groups. In terms of feeding practice, there was no significant difference in terms of the starting date of first enteral feeding (4.1+/-4.5 days vs. 3.5+/-3.6 days, IVF-ET twin group vs. spontaneous twin group), the time it took to reach full enteral feeding (26.7+/-20.5 days vs. 27.6+/-24.3 days), the time it took to reach full oral feeding (34.4+/-21.7 days vs. 34.3+/-24.1 days) and PMA upon full oral feeding (36.0+/-2.2 weeks vs. 36.0+/-1.8 weeks), the duration of total parenteral nutrition (23.1+/-21.0 days vs. 24.9+/-24.3 days), displaying similar oral feeding tolerance. CONCLUSION: There was no difference in oral feeding tolerance between two groups.

A Case of Wernicke's Encephalopathy in a Postoperative Patient with Parenteral Nutrition and Temporary Oral Feeding: A Case Report / 대한구급학회지

Wernicke's encephalopathy is an acute neurological disorder, caused by thiamine deficiency, which is clinically characterized by a triad of ophthalmoplegia, ataxia and disturbances of consciousness. Most frequently, the encephalopathy is a consequence of chronic alcoholism, but it may occur in other forms of malnutrition or malabsorption, such as in prolonged parenteral nutrition without the addition of thiamine, total gastrectomy, gastrojejunostomy, severe anorexia or hyperemesis gravidarum. Thiamine requirement increases during critical illness and in chronically depleted patients, and its supplementation may influence the outcome of the disease. We report a case of a 73-year-old man, who presented with recurred colon cancer, who was affected by Wernicke's encephalopathy while undergoing oral feeding and parenteral nutrition. This case suggests that we should be more aware of potential thiamine deficiency in critically ill patients, even those undergoing parenteral nutrition and temporary oral feeding.