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Objective:To analyze the paradigm and changes of enteral nutrition support for hospitalized children in Shanghai Children's Medical Center affiliated to School of Medicine of Shanghai, Jiao Tong University in last ten years, so as to provide guidance for nutritionists and dietitians on the application and management of enteral nutrition.Method:Relevant data were collected and analyzed from 2011 to 2020 in the Clinical Nutrition Department of Shanghai Children's Medical Center, including the implementation status of parenteral and enteral nutrition as well as the types and distribution of different enteral nutrition formulas and diet.Results:The Clinical Nutrition Department of our hospital provided seventy-five types of diet for hospitalized children. The utilization of ordinary diets and specialized diets has been stable at about 76,000 cases per year. In the past decade, twenty-one ordinary formulas and special formulas were provided every year by the Clinical Nutrition Department in our hospital and the utilization has been stable at 46,000 cases per year. The total consumption of ordinary formulas and the proportion of ordinary formulas users showed a descending trend. The proportion of specialized formulas users among discharged patients remained at 10%, with an upward trend in the proportion of high-calorie formulas and extensively-hydrolyzed formulas.Conclusions:The enteral nutrition formulas and inpatient diets are important components of nutritional treatment. The evolution of its clinical application to some extent reflects the changes of disease spectrum and the development of clinical disciplines. In short, the dietitians play a significant role in the nutrition support team.
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Objective@#To observe the changes in nutrition indicators and the effect on chemotherapy complications as well as the safety of enteral nutrition by way of providing enteral nutrition support for children with acute lymphoblastic leukemia (ALL) at the stage of induction chemotherapy.@*Methods@#From November 2016 to September 2017, 60 children with newly diagnosed ALL at the Hematology Oncology Center of Beijing Children′s Hospital were enrolled in this study.They were randomly divided into an experimental group and a control group, 30 cases for each group.The experimental group was given a high-calorie diet, high-quality protein, and high-medium-chain trigly-ceride enteral nutrition on the basis of a conventional low-fat diet, and the duration lasted the whole induction treatment of ALL children; while the control group was given a low-fat diet routinely.By analyzing relevant indicators before induction chemotherapy (D0), chemotherapy day 15 (D15), and after chemotherapy (D33), the changes in nutritional status and the effect on chemotherapy complications in 2 groups were investigated.@*Results@#There was no significant difference in the body mass index (BMI) and the thickness of triceps skinfold between 2 groups before and after chemotherapy (all P>0.05). The upper arm circumference increased after chemotherapy in the experimental group[before treatment: (15.80±2.63) cm, after treatment: (16.27±2.57) cm], while that of the control group decreased slightly[before chemotherapy: (17.19±3.71) cm, after chemotherapy: (17.15±3.64) cm], and the difference between 2 groups was statistically significant (P<0.05). After chemotherapy, the total protein levels in two groups decreased[the experimental group: (64.52±4.85) g/L, the control group: (61.97±4.65) g/L] which was significantly different from that before chemotherapy [the experimental group: (68.17±6.37) g/L, the control group: (68.08±5.14) g/L] (P<0.01). The total protein level of the experimental group after chemotherapy was significant higher than that in the control group (P<0.05). Both albumin levels in 2 groups increased after chemotherapy [(42.45±4.32) g/L in the experimental group and (41.15±3.73) g/L in the control group], and there was a significant difference between 2 groups before chemotherapy [(39.54±3.26) g/L in the experimental group and (40.01±4.37) g/L in the control group] (P<0.05). The level of prealbumin increased after chemotherapy in both groups [(324.57±64.328) mg/L in the experimental group and (293.07±69.09) mg/L in the control group] compared with that before chemotherapy [(121.10±35.13) mg/L in the experimental group and(131.20±52.77) mg/L in the control group]. The change was statistically significant (P<0.01). The albumin level in the experimental group before chemotherapy was lower than that in the control group after chemotherapy, but it was higher than that in the control group after chemotherapy.Protein differences were statistically significant (P<0.05). The reduction rate of elemental iron in the experimental group after chemotherapy was lower than that in the control group, but it was not statistically significant (P>0.05). Elemental zinc was not significantly different compared with the control group.The incidence of neutropenia after chemotherapy in ALL children was higher (37/60 cases, 61.67%). The recovery of neutropenia after chemotherapy in the experimental group was better than that in the control group.After chemotherapy, the severity of anemia in the experimental group was lighter than that in the control group.The amount of blood transfusion required and amount of transfusion per capita were less than those in the control group (54 person-times vs.74 person-times, 2.45 times vs.3.08 times). The total number of transfused blood products was less than that of the control group (78 person-times vs.101 person-times), but none of the findings above were statistically significant (all P>0.05). The degree of hepatic damage in the experimental group decreased after chemotherapy, but there was no significant change in the control group.The initial activated partial thromboplastin time(APTT) prolongation in the trial group was more than that in the control group (5 cases vs.3 cases), and less than the control group (0 case vs.1 case) after chemotherapy.The frequency of fever in the experimental group during chemotherapy was less than that in the control group (6 cases vs.8 cases), and the average time of fever was shorter than that in the control group (2.8 d vs.4.1 d). None of the above findings were statistically significant (all P>0.05). During the course of chemotherapy, 0 pancreatitis occurred in the experimental group, and 1 pancreatitis occurred in the control group.There was no difference in remission rates between 2 groups of chemotherapy for 15 days and chemotherapy for 33 days.@*Conclusions@#The nutritional status of children with ALL was reduced after initial induction chemotherapy.Enteral nutrition support was helpful to maintain the nutritional status for children at the initial stage of chemotherapy, high-calorie diet, high-quality protein, and high-medium-chain triglyceride enteral nutrition support improves blood system tolerance to chemotherapy and reduces chemotherapy complications.
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Objective To observe the effect of early enteral nutrition (EN) on immune function in patients with severe acute pancreatitis (SAP). Methods Nineteen patients with SAP admitted to Yinzhou People's Hospital of Ningbo City from March 11, 2015 to December 16, 2016 were enrolled, they were divided into two groups according to the different times of EN given, 11 patients who were early supported with EN were assigned in the research group and another 8 patients whose EN support was delayed were included in the control group. The patients in two groups were treated with routine non-operative western medicine after admission, and the jejunal nutritional tube was placed in the nasal cavity for EN administration. The research group was given early EN beginning at 72 hours after admission, on the first day, 250 mL sugar saline was administered at a rate of 60 mL/h, and on the second day and afterward, it was changed to 200 mL Ruineng (a commercial kind of EN); in the control group, the EN began on 7 to 10 days after admission, using the same principle and method as the research group; EN was given for 3 weeks in both groups. Venous blood was collected from each patient before and after the EN support, and immunoglobulin (IgG, IgM and IgA) levels were determined by immunoturbidimetry, the time of improved Marshall score ＜ 1 was observed. Results The levels of immunoglobulin IgG (g/L: 11.13±2.56 vs. 8.17±1.12), IgM (g/L: 1.71±0.96 vs. 0.76±0.71) and IgA (g/L: 3.74±1.85 vs. 2.13±0.13) in the research group after treatment were significantly higher than those before treatment (all P ＜ 0.05);the changes in the above indicators before and after treatment in the control group were not obvious [IgG (g/L): 8.32±0.93 vs. 8.21±1.04, IgM (g/L): 0.87±0.73 vs. 0.81±0.66, IgA (g/L): 2.15±0.37 vs. 2.11±0.17]. The levels of IgG, IgM and IgA in the research group after treatment were significantly higher than those in the control group (all P ＜ 0.05), the time of Marshall score ＜ 1 was siginificantly shorter than the research group than that in control group (days: 12.31±1.27 vs. 16.18±1.13, P ＜ 0.05). Conclusion Administration of EN as early as possible can effectively enhance the immune function of patients with SAP and improve their prognosis.
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Objective To observe the effect of electroacupuncture on early enteral nutrition (EEN) support in patients with severe craniocerebral injury.Methods A prospective, randomized, controlled study was conducted, 50 patients with severe craniocerebral injury admitted to the the Department of Intensive Care Unit of Traditional Chinese Medicine Hospital of Ningbo from January 2014 to October 2016 were enrolled, and they were randomly divided into electroacupuncture experimental group (26 cases) and conventional treatment control group (24 cases) by randome number table. Enteral nutrition (EN) support was implemented in 24 - 48 hours after admission for all the patients, additionally, the electroacupuncture experimental group was treated by electroacupuncture stimulating acupoint from the 1st day after admission, once 30 minutes daily for consecutive 10 days. The levels of EN calorie reaching standard situation and the parenteral nutrition (PN) necessary for addition were recorded on 3 days and 5 days after admission; the nasal feeding amount of the two groups was recorded on the 1, 4, 7 days; the incidences of complications during EN support period were observed in both groups.Results The proportion of EN calorie reaching the standard in electroacupuncture experimental group was significantly higher than that in the conventional treatment control group in 5 days of treatment [92.3% (24/26) vs. 70.8% (17/24),P < 0.05]. The proportions necessary for addition of PN support were lower in electroacupuncture experimental group than those in the conventional treatment control group on 3 days and 5 days of treatment [3 days: 19.2% (5/26) vs. 25.0% (6/24), 5 days: 7.7% (2/26) vs. 16.7% (4/24)], but there were no significant statistical differences between the two groups (bothP > 0.05). The nasal feeding amounts in electroacupuncture experimental group were significantly higher than those in the conventional treatment control group on 4 days and 7 days of treatment [4 days (mL): 1292.31±123.04 vs.1204.17±139.81,7 days (mL):1342.31±113.75 vs.1275.00±103.21, bothP < 0.05]. The incidence of complications of the electroacupuncture experimental group was significantly lower than that of the conventional treatment control group in 10 days of treatment [26.92% (7/26) vs. 41.67% (10/24),P < 0.05].Conclusions Application of electroacupuncture has a certain clinical value during implementing EN support for treatment of patients with severe craniocerebral injury, early intervention of electroacupuncture can effectively improve the patients' gastrointestinal function and elevate the successful rate of EN, and the therapy is simple, effective and safe without any obvious adverse reactions.
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Es conocida la alta prevalencia de desnutrición en pacientes hospitalizados, en los que el soporte nutricional es una herramienta clave de intervención. El objetivo fue describir las características y prácticas del soporte nutricional enteral en servicios de salud públicos del Departamento Central - Paraguay. Estudio observacional descriptivo transversal realizado en servicios de salud públicos del Departamento Central - Paraguay que brindan soporte nutricional enteral. Se aplicó una planilla de verificación para describir la planta física, infraestructura, equipamiento, organización y gestión, garantía de inocuidad y calidad y procedimientos relacionados a la nutrición enteral de los pacientes. Se utilizó como referencia la Guía de buenas prácticas, organización y funcionamiento de establecimientos de producción de fórmulas enterales y servicios de nutrición enteral. Un puntaje ≥70% fue considerado como un cumplimiento esperado. Se evaluaron 26 servicios de salud que fueron los que cumplían con los criterios de inclusión, de los cuales 20 correspondían al Ministerio de Salud Pública y Bienestar Social. Del total, 8 contaban con un espacio físico exclusivo para la preparación de fórmulas enterales; 10 cumplieron con los requisitos mínimos de planta física (de ellos, solo 3 tenían separación física de las áreas); 9 con infraestructura; 7 con equipamientos; 4 con la garantía de inocuidad y calidad; 8 con organización y gestión y 11 con los procedimientos relacionados a la nutrición enteral. Solo 6 cumplieron con un puntaje ≥70% (categoría "bueno"). Se observaron debilidades en el soporte nutricional enteral en servicios de salud públicos por lo que urge establecer medidas correctivas.
It is known the high prevalence of malnutrition in hospitalized patients, where nutritionalsupport is a key intervention tool. The objective was to describe the characteristics andpractices of the enteral nutritional support in public health services of the CentralDepartment-Paraguay. This was a cross-sectional study carried out in public health servicesof the Central Department in Paraguay that provide enteral nutritional support. A check listwas used to describe the physical structure, infrastructure, equipment, organization andmanagement, safety and quality assurance and procedures related to patient enteralnutrition. For the evaluation, a guide to good manufacturing practices, organization andoperation of enteral formulas production establishments and enteral nutrition services wasused as a reference. A score ≥70% was considered an expected compliance. Twenty six health services, which met inclusion criteria, were evaluated Twenty of them correspondedto the Ministry of Health. Eight of the total number had exclusive physical space for thepreparation of the enteral formulas; 10 met the minimum requirements for physicalstructure (only 3 had physical separation of areas); 9 had infrastructure; 7equipment; 4safety and quality assurance; 8 organization and management and 11 procedures regardingthe enteral nutrition. Only 6 met ≥70% score ("good" category).Weaknesses were observedin the enteral nutritional support of public health services, therefore to establish correctiveactions is urgent.
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Humans , Malnutrition , Enteral Nutrition , Public HealthABSTRACT
Objective To learn the effect of individualized nutritional support in the treatment of severe acute pancreatitis and provide an effective nutritional support therapy for the disease.Methods 97 patients of severe acute pancreatitis were randomly divided into 51 cases of observation group and 46 cases of control group.The control group was given standard parenteral nutrition.The observation group was given the same heat and support stage of individual nutrition nitrogen.Hemoglobin (Hb),albumin (ALB),pre albumin (PA)and transferrin (TFN)of the two groups were detected before and after treatment.The recovery time of serum amylase,resumed oral intake time, hospitalization time and hospitalization expenses of the two groups were observed.The occurrence of gastrointestinal complications was observed in the two groups during the treatment period.Results Compared with before treatment, after treatment Hb,ALB,PA,TFN of the two groups were significantly increased (t =4.114,7.540,5.556,8.307 and 1.994,3.970,2.906,5.099,all P 0.05).Conclusion In the treatment of severe acute pancreatitis,individualized nutritional support has better curative effect,low incidence of complications,with good clinical application value.
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ObjectiveTo observe the clinical curative effect of nasal jejunal nutrition support in stroke patients with gastric retention.Methods Forty-two patients with cerebral apoplexy combined with gastric retention admitted to Dingxing County Hospital in Hebei province from March 2012 to November 2015 and treated with enteral nutrition support were enrolled, and they were divided into observation group and control group according to the random number table method, 21 cases in each group. Under the guidance, routine treatment were given, the head of bed was raised to 30°- 45°, and gastrointestinal decompression was carried out in the two groups. In the observation group, a nasal jejunal tube was inserted and enteral nutrition was given, while in the control group, parenteral nutrition was firstly applied until the recovery of gastrointestinal function, then nasogastric enteral nutrition was carried out. Compared between the two groups, on the day of admission before treatment and 2 weeks after treatment, blood glucose levels, plasma total protein levels, albumin were detected; the triceps skinfold thickness (TSF), upper arm circumference (MAC), upper arm muscle circumference (AMC), etc were measured in the two groups to show the difference in nutritional status. Adverse reactions of diarrhea, stress ulcer, gastrointestinal tract infection, reverse flow, high blood sugar and central venous infection and complications in the two groups were observed.Results The levels of blood glucose, albumin, total protein content were not significantly different between the two groups before treatment (allP > 0.05). Blood glucose levels in the two groups after treatment were lower than those on admission, and the decrease in the observation group was more significant (mmol/L: 6.45±2.15 vs. 7.68±2.68,P < 0.05); the levels of albumin and total protein in the control group after treatment were lower than those on admission, while the observation group had no such significant changes, and the levels of the control group were significantly lower than those of the observation group [albumin (g/L): 30.78±4.12 vs. 38.20±4.67, total protein (g/L): 63.91±4.32 vs. 67.11±3.12, P < 0.05]. After treatment for 2 weeks, the nutritional indexes of TSF, MAC, AMC in the two groups were slightly lower than those on admission, but the degrees of descent in observation group were not as significant as those in the control group [TSF (mm): 11.91±1.29 vs. 10.13±1.37, MAC (cm): 24.19±3.12 vs. 23.74±2.08, AMC (cm): 22.64±2.05 vs. 21.73±2.15, allP < 0.05]. The incidences of adverse reactions and complications in the observation group were significantly lower than those in the control group [diarrhea: 9.5% vs. 38.1%, stress ulcer: 4.8% vs. 33.3%, regurgitation:4.8% vs. 28.6%, hyperglycemia: 9.5% vs. 38.5%,P < 0.05]; In the control group, the incidence of central venous infection was 4.8%.Conclusions Gastric jejunal nutrition support in patients with cerebral apoplexy combined with gastric retention can prevent occurrence of malnutrition, reduce the incidences of adverse reactions and complications and promote the rehabilitation of patients.
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Objective To explore the impact of enteral nutrition (EN)support on patients with advanced cancer.Methods 83 cases with advanced cancer were selected,the patients were randomly divided into two groups, 42 cases in the observation group,41 cases in the control group.The observation group was given EN support com-bined with parenteral nutrition (PN)support,while the control group was only given the PN support.Immune function CD +4 ,CD +4 /CD +8 ,IgA,IgG,nutrition indicators [serum albumin (ALB),transferrin (TF)and 24h urea nitrogen (24hUP)]before and 10d after surgery as well as complications were compared.Results The differences of CD +4 , CD +4 /CD +8 ,IgA,IgG,ALB,TF and 24h UP between the two groups before surgery were not statistically significant (P >0.05);10d after surgery,CD +4 ,CD +4 /CD +8 ,IgA,IgG levels in the control group were (52.4 ±4.4)%,(1.8 ± 0.3)%,(2.7 ±0.3)g/L and (11.4 ±2.1)g/L,which in the observation group were (55.9 ±5.6)%,(2.1 ± 0.5)%,(2.9 ±0.5)g/L and (12.9 ±2.3)g/L,CD +4 /CD +8 ,IgA,IgG were significantly higher in the observation group(t =2.408,2.521,2.332,2.359,all P <0.05);10d after surgery,ALB,TF and 24h UP in observation group were (36.6 ±2.3)g/L,(2.9 ±0.2)g/L,and (0.7 ±0.3)g/L,which were (32.4 ±1.5)g/L,(2.2 ±0.1)g/L,and (0.4 ±0.1)g/L in the control group,the differences were statistically significant (t =7.493,15.34,4.648,P <0.05).The incidence rate of complications in the observation group was 9.5% (4 /42),which in the control group was 26.8%(11 /41),the difference was statistically significant (χ2 =4.196,P <0.05).Conclusion EN support for patients with advanced cancer is benefit for immune function improvment and nutrition improvement,and can reduce the risk of complications.