Early enteral feeding guided by intestinal ultrasound during therapeutic hypothermia for hypoxic-ischemic encephalopathy in neonates / 中国新生儿科杂志

Objective:To study the safety and feasibility of early enteral feeding during therapeutic hypothermia guided by intestinal ultrasound in neonates with hypoxic-ischemic encephalopathy (HIE).Methods:From January 2019 to December 2021, neonates with HIE who received therapeutic hypothermia in the neonatology department of our hospital were retrospectively selected. They were assigned into the ultrasound-guided observation group (admitted from May 2020 to December 2021) and the control group (admitted from January 2019 to April 2020). In the ultrasound-guided observation group, intestinal ultrasound was performed during therapeutic hypothermia. Based on clinical manifestations and ultrasound results, a small amount of enteral feeding [20 ml/(kg·d)] was initiated and gradually increased to total enteral feeding after rewarming. In the control group, 5 ml (once every 3 h) of glucose and sodium chloride solution was given during 72 h of therapeutic hypothermia. After rewarming, enteral feeding was started and gradually increased to total enteral feeding without intestinal ultrasound. The time to start enteral feeding, the time to achieve total enteral feeding, the incidences of feeding intolerance, necrotizing enterocolitis (NEC) and late-onset sepsis were compared between the two groups.Results:A total of 17 cases were in the ultrasound-guided observation group and 18 cases in the control group. The median time to start enteral feeding and to achieve total enteral feeding in the ultrasound-guided observation group were earlier than the control group [36.0 (33.5, 39.0) h vs. 77.0 (74.0, 79.3) h, 6.0 (5.5, 6.5) d vs. 8.0 (7.0, 9.0) d, P<0.001]. No significant difference existed in the incidence of feeding intolerance between the two groups. Neither groups had NEC or late-onset sepsis. Conclusions:Early enteral feeding during therapeutic hypothermia in neonates with HIE is safe and feasible. Intestinal ultrasound helps implementing feeding plan and achieving early total enteral feeding.

Impact of early-onset preeclampsia on feeding tolerance and growth of very low birth weight infants during hospitalization / Efeito da pré-eclâmpsia precoce na tolerância alimentar e no crescimento de recém-nascidos de muito baixo peso durante a hospitalização

ABSTRACT Objective: The provision of adequate enteral nutrition to preterm infants is a great challenge, and preeclampsia (PE) may have a detrimental effect on the safety of nutrition supply. This study aims to investigate the influence of early-onset PE on preterm infants' enteral feeding tolerance and growth during hospitalization. Methods: This is a prospective study with 55 preterm infants <34 weeks born to PE mothers matched by gestational age with 55 preterm infants born to normotensive mothers from 2013 to 2016. We evaluated maternal, gestational, and neonatal clinical data. The outcomes were feeding intolerance and growth during hospitalization. Comparison between groups was performed by Student's t-test or Mann-Whitney U test, chi-square test, or Fisher's exact test. Multiple logistic regression was used to investigate whether PE was an independent risk factor for feeding intolerance. Results: The mean gestational age was 30 weeks. Preterm infants of mothers with PE had lower birth weight and were smaller at discharge. Feeding intolerance was frequent, but necrotizing enterocolitis was rare in this sample (PE=4% vs. control=2%) with no difference between groups. Preterm infants of mothers with PE had worse growth outcomes; however, PE was not an independent risk factor for feeding intolerance. The increase in gestational age was a protective factor, and being born small for gestational age (SGA) increased the risk of feeding intolerance by six times. Conclusions: Preterm infants of mothers with early-onset PE were more likely to be born SGA and had a worse growth trajectory during hospitalization. In adjusted analyses, however, low gestational age and SGA were independent predictors of feeding intolerance.

RESUMO Objetivo: A nutrição enteral adequada para recém-nascidos prematuros é um grande desafio, e a pré-eclâmpsia (PE) pode comprometer a segurança da oferta alimentar. O objetivo deste estudo é investigar a influência da PE de início precoce na tolerância alimentar e no crescimento de prematuros durante a hospitalização. Métodos: Estudo prospectivo, com 55 prematuros <34 semanas de mães com PE pareados por idade gestacional e com 55 prematuros de mães normotensas, de 2013 a 2016. Foram avaliados dados clínicos maternos, gestacionais e neonatais. Os desfechos foram intolerância alimentar e crescimento durante a hospitalização. Na comparação entre grupos, utilizaram-se teste t de Student ou de Mann-Whitney e teste qui-quadrado ou exato de Fisher. Regressão logística múltipla foi usada para investigar se a PE é fator de risco para intolerância alimentar. Resultados: A idade gestacional média foi de 30 semanas. Prematuros de mães com PE tiveram menor peso ao nascer e eram menores na alta. A intolerância alimentar foi frequente, mas a enterocolite necrosante foi rara nesta amostra (PE=4% vs. controle=2%), sem diferença entre grupos. Prematuros de mães com PE tiveram pior crescimento, mas a PE não foi fator independente de risco para intolerância alimentar. O aumento da idade gestacional foi fator de proteção, e nascer pequeno para a idade gestacional (PIG) aumentou em seis vezes o risco de intolerância alimentar. Conclusões: Prematuros de mães com PE de início precoce tiveram maior probabilidade de nascer PIG e pior trajetória de crescimento na hospitalização. Em análises ajustadas, baixa idade gestacional e PIG foram preditores independentes de intolerância alimentar.

“Comparative Study on Complications of Early Enteral Feeding and Nil Per Oral in Mild and Moderate Acute Pancreatitis”

Introduction: Acute pancreatitis is a potentially lethal disease with wide variation in severity ranging from mild and self-limiting to a rapidly progressive illness leading to multiorgan failure. In accordance with this wide variation in clinical presentation, the treatment of acute pancreatitis requires a multidisciplinary approach. Mild acute pancreatitis causes disturbance in the homeostatic mechanism of the body is minimal; the treatment is aimed at supporting the native reparative processes of the body. One of the main supportive mechanisms is adequate and safe nutritional supplementation. Objectives: To assess the occurrence of infective and non-infective complications in cases of acute pancreatitis on early enteral nutrition. Materials & Methods: This is a prospective study conducted on patients who were admitted to SSIMS AND RC Davangere with symptoms suggestive of acute pancreatitis from July 2019 to July 2021. Patients with a clinical picture consistent with the diagnosis of acute pancreatitis, along with more than a 3-fold elevation of serum amylase and elevated serum lipase were considered to have acute pancreatitis. After initial diagnosis and assessment, patients were duly informed regarding the study and consent was obtained. A 16-gauge nasogastric Ryle’s tube was inserted for all patients included in the study. The feeding patterns were initiated depending upon the severity of acute pancreatitis. Feeding was started after calculating the nutrition requirement. In the early feeding group, patients were given a protein powder to achieve a target nutrition in a stepwise manner. The tolerance to feeds, infective and non-infective complications and the time taken to start on an oral diet were noted and analysed. Results: The incidence of infective complications in our study was found to be 2% with none of the infections involving the pancreas itself. The incidence of non-infective complications in our study was found to be 30% with 13% involving the pancreas proper. Conclusions: The use of early enteral feeding does not influence the incidence of infective and non-infective complications in mild and moderate acute pancreatitis. Early enteral feeding delivers nutrition, in a simpler and more cost-effective. Nasogastric and oral feeding reduces the morbidity of the patient by accelerating the return to normal activities.

Influence of enteral feeding initiation time on intestinal flora and metabolites in very low birth weight infants: a prospective study / 中国当代儿科杂志

OBJECTIVES@#To study the influence of enteral feeding initiation time on intestinal flora and metabolites in very low birth weight (VLBW) infants.@*METHODS@#A total of 29 VLBW infants who were admitted to the Department of Neonatology, Children's Hospital of Chongqing Medical University, from June to December, 2020, were enrolled as subjects. According to the enteral feeding initiation time after birth, the infants were divided into two groups: <24 hours (n=15) and 24-72 hours (n=14). Fecal samples were collected at weeks 2 and 4 of hospitalization, and 16S rDNA high-throughput sequencing and gas chromatography-mass spectrometry were used to analyze the microflora and short-chain fatty acids (SCFAs) respectively in fecal samples.@*RESULTS@#The analysis of microflora showed that there was no significant difference between the two groups in Chao index (reflecting the abundance of microflora) and Shannon index (reflecting the diversity of microflora) at weeks 2 and 4 after birth (P>0.05). The analysis of flora composition showed that there was no significant difference in the main microflora at the phylum and genus levels between the two groups at weeks 2 and 4 after birth (P>0.05). The comparison of SCFAs between the two groups showed that the <24 hours group had a significantly higher level of propionic acid than the 24-72 hours group at week 4 (P<0.05), while there was no significant difference in the total amount of SCFAs and the content of the other SCFAs between the two groups (P>0.05).@*CONCLUSIONS@#Early enteral feeding has no influence on the diversity and abundance of intestinal flora in VLBW infants, but enteral feeding within 24 hours can increase the level of propionic acid, a metabolite of intestinal flora.

Evidence-based standardized nutrition protocol can shorten the time to full enteral feeding in very preterm/very low birth weight infants / 中国当代儿科杂志

OBJECTIVES@#To investigate whether evidence-based standardized nutrition protocol can facilitate the establishment of full enteral nutrition and its effect on short-term clinical outcomes in very preterm/very low birth weight infants.@*METHODS@#A retrospective analysis was performed on the medical data of 312 preterm infants with a gestational age of ≤32 weeks or a birth weight of <1 500 g. The standardized nutrition protocol for preterm infants was implemented in May 2020; 160 infants who were treated from May 1, 2019 to April 30, 2020 were enrolled as the control group, and 152 infants who were treated from June 1, 2020 to May 31, 2021 were enrolled as the test group. The two groups were compared in terms of the time to full enteral feeding, the time to the start of enteral feeding, duration of parenteral nutrition, the time to recovery to birth weight, the duration of central venous catheterization, and the incidence rates of common complications in preterm infants.@*RESULTS@#Compared with the control group, the test group had significantly shorter time to full enteral feeding, time to the start of enteral feeding, duration of parenteral nutrition, and duration of central venous catheterization and a significantly lower incidence rate of catheter-related bloodstream infection (P<0.05). There were no significant differences between the two groups in the mortality rate and the incidence rate of common complications in preterm infants including grade II-III necrotizing enterocolitis (P>0.05).@*CONCLUSIONS@#Implementation of the standardized nutrition protocol can facilitate the establishment of full enteral feeding, shorten the duration of parenteral nutrition, and reduce catheter-related bloodstream infection in very preterm/very low birth weight infants, without increasing the risk of necrotizing enterocolitis.

Effects of enteral nutrition beginning at different time on aspiration rate and immune function in patients with severe traumatic brain injury / 中国康复理论与实践

@#Objective To investigate the effect of enteral nutritional support beginning at different time on aspiration events and immune function in the early post-traumatic (within 14 days) period in patients with severe traumatic brain injury.Methods From June, 2018, to February, 2021, 75 patients with acute traumatic brain injury admitted in the Department of Neurosurgery of the Second People's Hospital of Lianyungang were randomly divided into early feeding group (24 to 48 hours, n=35) and delayed feeding group (48 to 120 hours, n=40). The 14-day reflux rate, aspiration rate, incidence of aspiration pneumonia, immune indexes and complications were compared between two groups.Results There was no significant difference in the reflux rate, aspiration rate and the incidence of aspiration pneumonia between the two groups (P > 0.05). The levels of IgG, IgA, and complements C3 and C4 were significantly higher in the early feeding group than in the delayed feeding group (|t| > 1.720, P<0.001). The incidence of non-aspiratory lung infections was significantly lower in the early feeding group than in the delayed feeding group (χ2=4.728, P<0.05).Conclusion Initiating enteral nutrition within 24 to 48 hours after injury may preserve immune function and reduce the incidence of non-aspiratory lung infections in patients with severe traumatic brain injury.

Rapid versus slow feeding advancement in preterm low birth weight neonates: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>Objectives:</strong> To compare the clinical outcomes of rapid versus slow enteral feeding advancement in preterm low birth weight neonates.</p><p style="text-align: justify;"><strong>Methods:</strong> Searches for randomized controlled trials evaluating the effect of rapid versus slow rate of enteral feeding advancement on the clinical outcomes of preterm, low birth weight neonates were performed in different databases. Two authors screened the articles for inclusion and statistical analysis was done using Review Manager Version 5.3 (RevMan) software.</p><p style="text-align: justify;"><strong>Results:</strong> Six trials with a total of 680 subjects comparing enteral feeding advancement protocols were identified. The number of days to reach full feeds in rapid enteral feeding was shorter by 2.79 days (95% CI 1.39, 4.19) and time to regain weight by 3.72 days (95% CI 2.86, 4.59) compared to slow enteral feeding. There was no significant difference in the incidence of feeding intolerance (OR 0.69, 95% CI 0.42, 1.11) and NEC (OR 0.88, 95% CI 0.45, 1.72) between the two groups.</p><p style="text-align: justify;"><strong>Conclusions:</strong> Rapid enteral feeding protocols reduce the time to establish full enteral feeds and to regain birth weight in preterm low birth weight neonates. Rapid enteral feeding may facilitate early discharge and help reduce hospital costs for the care of these neonates.</p>

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study

ABSTRACT BACKGROUND: During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE: To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING: Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS: Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS: Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION: Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

Adult avoidant/restrictive food intake disorder: a case report / Transtorno alimentar evitativo/restritivo em uma adulta: um relato de caso

ABSTRACT The aim this report is to present an adult case of avoidant/restrictive food intake disorder (ARFID) in a patient with atypical development. To emphasize the diagnostic and behavioral characteristics of this new nosological category included in the Feeding and Eating Disorders (FED) section of DSM-5. A woman with Down Syndrome in early adulthood who developed restriction and avoidance symptoms of food until the total eating refusal with weight loss, malnutrition and dependence exclusively on enteral feeding by gastrostomy tube. This case exemplified how ARFID may remain a hidden diagnosis and even be misdiagnosed as other eating disorders, such as anorexia nervosa. The increase in diagnostic suspicion for this nosological entity with neurobiological/behavioral mechanisms involved in its clinical presentations in mind, might increase knowledge about this serious eating disorder, aiming the development of evidence-based interventions.

RESUMO O objetivo deste relato é apresentar um caso de transtorno alimentar evitativo/restritivo (TARE) em uma paciente adulta com desenvolvimento atípico e salientar as características diagnósticas e comportamentais dessa nova categoria nosológica incluída na seção de Transtornos Alimentares da DSM-5. Mulher com síndrome de Down que, no início da vida adulta, evoluiu com sintomas de restrição e evitação alimentar até a recusa total da alimentação, com perda de peso, desnutrição e dependência total de alimentação enteral por gastrostomia. Este caso elucida como o diagnóstico de TARE pode permanecer oculto e ser confundindo com outras condições patológicas alimentares, como a anorexia nervosa. O aumento da suspeição diagnóstica para essa entidade nosológica, tendo em mente os mecanismos neurobiológicos/comportamentais envolvidos em suas apresentações clínicas, possibilitará o aumento do conhecimento sobre esse grave transtorno alimentar, visando ao desenvolvimento de intervenções eficazes baseadas em evidências.

Early Aggressive Enteral Feeding in Neonates Weighing 750-1250 Grams: A Randomized Controlled Trial

Background: In preterm neonates, enteral feeding is advancedslowly, considering the risk of necrotizing enterocolitis. Prolongedintravenous alimentation in these neonates, however, mayincrease the risk of sepsis-related morbidity and mortality,particularly in low resource settings.Objectives: Objective of this was study to evaluate impact ofaggressive enteral feeding on mortality and morbidities amongpreterm neonates.Design: Randomized controlled trial.Participants: Neonates with birthweight 750-1250 g.Interventions: 131preterm neonates with birth weight 750-1250g, admitted to neonatal intensive care unit between April 2012 andJune 2014, were randomized to aggressive feeding orconservative feeding regimen.Outcomes: The primary outcome of the study was all-causemortality during hospital stay. The secondary outcomes includedproportion of sepsis (blood culture proven), necrotizingenterocolitis, feed intolerance, survival without major morbidity atdischarge, time to reach full enteral feed (180 mL/kg/d), durationof hospitalization, and average daily weight gain (g/kg).Results: All-cause mortality was 33.3% in aggressive regimenand 43.1% in conservative regimen, [RR (95%) CI 0.77 (0.49,1.20)]. Neonates with aggressive feeding regimen reached fullenteral feed earlier; median (IQR) 7 (6, 8) days compared toconservative regimen, 10 (9, 14) days; P <0.001. There was nodifference in culture positive sepsis rate, survival without majormorbidities, feed intolerance, necrotizing enterocolitis, duration ofhospitalization and average daily weight gain.Conclusions: In neonates with birth weight 750-1250 g, earlyaggressive feeding regimen is feasible but not associated withsignificant reduction in all-cause mortality, culture positive sepsisor survival without major morbidities during hospital stay.Neonates with aggressive regimen have fewer days on IV fluidsand reach full feed earlier

Survey on Accumulated Drug Information by Pharmaceutical Companies about Crushed or Simply Suspended Internal Medicines / 医薬品情報学

Objective: We conducted a survey on drug information accumulated by pharmaceutical companies about the adequacy of administration of crushed or simply suspended internal medicines through enteral feeding tube, examination methods to confirm adequacy and inquiries from medical institutions to pharmaceutical companies about the adequacy of these methods.Methods: We sent a questionnaire to 162 pharmaceutical companies that sell internal medicines to collect information. The survey was conducted from May 1, 2016 to March 31, 2017.Results: The questionnaire response rate was 61% (99 companies responded). Eighty and 90 percent of the companies possessed information about the drug crushing methods and simple suspension methods used for administration of internal medicines,respectively. The type of information and examination methods used varied among the companies, was very limited, and was often limited to new drugs. The information acquisition rate about crushing methods was 69.3% in original examination methods of pharmaceutical companies. On the other hand, 90.3% of the information about simple suspension methods was obtained by the unified method of Hand Book of Simple Suspension Method.Conclusions: In the future, medical practice and patients will benefit if examination methods to confirm the adequacy of crushing and administration through feeding tubes are commonly and consistently obtained by pharmaceutical companies. Furthermore, it would be very useful for information of crushing methods and simple suspension methods to be included in package inserts and interview forms.

Comparison of Micronutrient Levels between Oral Feeding and Enteral Feeding in Chronic Stroke Patients / 대한연하장애학회지

OBJECTIVE: This study aimed to investigate the difference in micronutrient levels between oral feeding and enteral feeding in chronic stroke patients to assess the risks of enteral feeding. METHODS: Patients with chronic stroke who were admitted to the Department of Rehabilitation Medicine between January 2011 and June 2012 were enrolled. The serum concentrations of iron, copper, zinc, folate, and vitamin B12, as well as the absolute CD4 and CD8 lymphocyte counts, were assessed. RESULTS: Of the 73 patients enrolled in this study, 50 were fed orally, while the other 23 were fed through a percutaneous endoscopic gastrostomy (PEG) or nasogastric (NG) tube. The serum concentrations of vitamin B12 and folate were significantly higher in the enteral feeding group than in the oral feeding group. However, the serum concentration of zinc was significantly lower in the enteral feeding group. CONCLUSION: There is little difference between enteral feeding and oral feeding in terms of micronutrient provision except that the serum concentration of zinc in the enteral feeding group was significantly lower than that in the oral feeding group. Clinicians should recognize that chronic stroke patients who require tube feeding have a risk of micronutrient deficiency. Early detection of malnutrition and micronutrient deficiency is important for providing the necessary nutrients.

Duodenoduodenal Intussusception due to a Migrated Percutaneous Radiologic Gastrostomy Tube: A Case Report / 대한연하장애학회지

Patients with dysphagia often have difficulty in supplying adequate nutrition orally, and thus they often use gastrostomy for nutrition support. If the nutrition affects the deterioration of the disease, as in amyotrophic lateral sclerosis, the majority of patients will have a gastrostomy tube for proper nutrition. To prevent complications from gastrostomy tubes, it is important to educate the caregiver or patient about how to properly manage it. If these patients opt for home care because of financial or cultural reasons, it will be difficult for their healthcare team to observe them closely, leading to complications due to lax tube management. In this case, appropriate management education becomes more important. This paper reports an extremely rare case of duodenal intussusception caused by a migrated percutaneous radiologic gastrostomy (PRG) tube in a patient with amyotrophic lateral sclerosis (ALS) using simultaneous oral and enteral nutrition. The patient was treated successfully with urgent tube removal using the air reduction maneuver. This case highlights the importance of gastrostomy management.

La alimentación enteral como cuidado paliativo (en el contexto de una enfermedad terminal). Una reflexión desde la biopolítica / Enteral feeding as palliative care (in the context of a terminal disease). A reflection from biopolitics / Alimentação enteral como cuidados paliativos (no contexto de uma doença terminal). Uma reflexão da biopolítica

En este trabajo se ofrece una problematización del dilema ético que representa el procedimiento médico de la alimentación enteral aplicado como un cuidado paliativo en el contexto de una enfermedad terminal. La hipótesis interpretativa es que este procedimiento puede ser visto desde una perspectiva biopolítica. Para sostener la tesis se hace una reflexión sobre los fundamentos que el Estado Moderno esgrime para la defensa de la vida desde las prácticas médicas con una perspectiva hipocrática, conformando así mecanismos de control de la vida. Acorde con la tesis, la alimentación enteral como cuidado paliativo se presentaría como una de las prácticas médicas que ejemplifican de manera más patente la intención del control político de la vida humana, tanto biológica como cultural.

This paper offers a problematization of the ethical dilemma that represents the medical procedure of enteral feeding as palliative care in the context of a Terminal disease. The interpretative hypothesis is that this procedure can be viewed from a biopolitical perspective.To support the thesis, I refer the basis that the Modern State uses to defend life from medical practices with a Hippocratic perspective, thus conforming mechanism for the control of life. According to the thesis enteral nutrition as palliative care would be presented as one of the medical practices that more clearly exemplify the intention of political control of human life.

Neste trabalho oferece-se uma problematização do dilema ético que representa o procedimento médico da alimentação enteral aplicado como um cuidado paliativo no contexto de uma doença terminal. A hipótese interpretativa é que este procedimento pode ser visto de uma perspectiva biopolítica. Para sustentar a tese se faz uma reflexão sobre os fundamentos que o Estado Moderno esgrime para a defesa da vida desde as práticas médicas com uma perspectiva hipocrática, conformando assim mecanismos de controle da vida. De acordo com a tese, a alimentação enteral como cuidado paliativo se apresentaria como uma das práticas médicas que exemplificam de maneira mais evidente a intenção do controle político da vida humana, tanto biológica como cultural.

Effect of Active Nutrition Care on Underweight Elderly Patients Receiving Long-term Enteral Tube Feeding / 대한지역사회영양학회지

OBJECTIVES: This study was performed to investigate the effect of active nutrition care on feeding and nutritional status of elderly patients receiving long-term enteral tube feeding. METHODS: Subjects included 77 elderly patients who had received enteral nutrition more than one week before admission. Nutrition care was provided to patients supplied less calories than required. Feeding intolerance was examined and managed every day and formula was adjusted to meet nutritional requirement during the first 3 months after admission. Patients were classified into under or over 80% of percent ideal body weight (PIBW) and medical records were used to compare changes in weight,, biochemical indices, and nutritional status during the study. RESULTS: Weight, BMI, triglyceride and total cholesterol in blood, hemoglobin, and hematocrit levels were significantly lower in patients under 80% of the PIBW than in those over 80% of the PIBW at admission. The percentage of supply to required calories was also lower in patients under 80% of the PIBW. After 1 month of nutritional care, supplied volume of formula was significantly increased in patients under 80% of the PIBW. Weight, BMI, and PIBW were increased and there were no differences between groups after 6 months. In addition, the concentrations of triglyceride and total cholesterol in blood, hemoglobin, and hematocrit tended to increase in patients under 80% of the PIBW, leading to no difference between groups after 3 months. CONCLUSIONS: Personalized active nutrition care is effective to increase weight and improve feeding and nutritional status in underweight elderly patients receiving longterm enteral nutrition.

Effect of Active Nutrition Care on Underweight Elderly Patients Receiving Long-term Enteral Tube Feeding / 대한지역사회영양학회지

OBJECTIVES: This study was performed to investigate the effect of active nutrition care on feeding and nutritional status of elderly patients receiving long-term enteral tube feeding. METHODS: Subjects included 77 elderly patients who had received enteral nutrition more than one week before admission. Nutrition care was provided to patients supplied less calories than required. Feeding intolerance was examined and managed every day and formula was adjusted to meet nutritional requirement during the first 3 months after admission. Patients were classified into under or over 80% of percent ideal body weight (PIBW) and medical records were used to compare changes in weight,, biochemical indices, and nutritional status during the study. RESULTS: Weight, BMI, triglyceride and total cholesterol in blood, hemoglobin, and hematocrit levels were significantly lower in patients under 80% of the PIBW than in those over 80% of the PIBW at admission. The percentage of supply to required calories was also lower in patients under 80% of the PIBW. After 1 month of nutritional care, supplied volume of formula was significantly increased in patients under 80% of the PIBW. Weight, BMI, and PIBW were increased and there were no differences between groups after 6 months. In addition, the concentrations of triglyceride and total cholesterol in blood, hemoglobin, and hematocrit tended to increase in patients under 80% of the PIBW, leading to no difference between groups after 3 months. CONCLUSIONS: Personalized active nutrition care is effective to increase weight and improve feeding and nutritional status in underweight elderly patients receiving longterm enteral nutrition.

Multi-center Study of Enteral Feeding Practices in Hospitalized Late Preterm Infants in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the current enteral feeding practices in hospitalized late preterm infants in the Beijing area of China.</p><p><b>METHODS</b>A multi-center, cross-sectional study was conducted. Infants born after 34 weeks and before 37 weeks of gestation were enrolled from 25 hospitals in the Beijing area of China from October 2015 to October 2017. Data on enteral feeding practices were collected and analyzed.</p><p><b>RESULTS</b>A total of 1,463 late preterm infants were enrolled, with a mean gestational age (GA) of 35.6 (34.9, 36.1) weeks. The percentage of exclusive breastfeeding was 4.5% at the initiation of enteral feeding but increased to 14.4% at discharge. When human milk was not available, most infants (46.1%) were fed with preterm infant formula. The rate of exclusive human milk feeding in infants born at 34 weeks gestation was higher than at discharge (21.1% of infants born at 34 weeks' GA versus 12.1% of infants born at 35 weeks' GA versus 12.3% of infants born at 36 weeks' GA, P < 0.001). Only 28.4% of late preterm infants achieved full enteral feeding at discharge, and only 19.2% achieved 120 kcal/(kg•d) by enteral feeding at discharge. Importantly, 40.5% of infants did not regain the birth weight at discharge.</p><p><b>CONCLUSION</b>Enteral feeding support of late preterm infants has not been standardized to achieve optimal growth. Moreover, the human milk feeding rate was low, and many late preterm infants did not achieve the goal of enteral feeding and failed to regain birth weight at the time of discharge. More aggressive enteral feedings protocols are needed to promote human milk feeding and optimize growth for late preterm infants.</p>

Impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation: a prospective randomized controlled study / 中华危重病急救医学

Objective To compare the impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation (MV). Methods A prospective randomized controlled study was conducted. Eighty-two patients requiring MV admitted to intensive care unit (ICU) of Anji People's Hospital from January 2015 to March 2017 were enrolled, and they were randomly divided into the permissive underfeeding group (n = 40, non-protein heat was 52.3-62.8 kJ·kg-1·d-1, protein was 1.2-1.5 g·kg-1·d-1) and standard enteral feeding group (n = 42, non-protein heat was 104.6-125.5 kJ·kg-1·d-1, protein was 1.2-1.5 g·kg-1·d-1). Permissive underfeeding group received 50% of their daily energy expenditure via enteral nutrition (EN) and standard enteral feeding group received 100% of their daily energy expenditure via EN in 24-48 hours after admitted to ICU. Nutritional status [pro-albumin (PA), serum albumin (ALB)], inflammation state [procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP)] were detected before treatment and 7 days after treatment. Duration of MV, length of ICU stay, daily insulin dosage, 28-day mortality, hospital acquired pneumonia (HAP), urinary tract infection, septic shock and other secondary infection, and the nutrition related complications were recorded. Results Compared with before treatment, the levels of serum PA (mg/L) and ALB (g/L) were significantly increased, the levels of PCT (ng/L) and hs-CRP (mg/L) were significantly decreased at 7 days after treatment in both groups [permissive underfeeding group: PA was 127.42±65.83 vs. 80.92±60.14, ALB was 30.16±4.32 vs. 25.36±6.21, PCT was 375.8±227.2 vs. 762.3±314.5, hs-CRP was 32.19±7.53 vs. 120.48±60.24; standard enteral feeding group: PA was 132.56±61.32 vs. 86.78±47.06, ALB was 31.25±4.63 vs. 26.71±5.48, PCT was 412.1±323.4 vs. 821.7±408.6, hs-CRP was 35.86±5.69 vs. 116.38±72.16, all 1 < 0.05], but there was no significant difference in PA, ALB, PCT or hs-CRP at 7 days after treatment between two groups (all 1 > 0.05). There was no significant difference in the duration of MV, length of ICU stay, 28-day mortality or ICU-associated infection between two groups [duration of MV (hours): 162.35±20.37 vs. 153.48±18.65, length of ICU stay (days): 7.52±1.61 vs. 6.34±1.87, 28-day mortality: 17.5% vs. 19.0%, ICU-associated infection: 45.0% vs. 47.6%, all 1 > 0.05]. Compared with standard enteral feeding, insulin demand was significantly decreased (U/d: 13.68±10.36 vs. 26.24±18.53), and gastrointestinal intolerance was less frequent (32.5% vs. 54.8%) in the permissive underfeeding group (both 1 < 0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference between the two groups (χ2= 3.216, 1 = 0.068). Conclusion The curative effect and prognosis of MV severe patients receiving permissive underfeeding are similar to those of standard enteral feeding, but it can reduce the dosage of insulin with better gastrointestinal tolerance.

Research progress of enteral nutrition in very low birth weight infants / 中华实用儿科临床杂志

The nervous system of very low birth weight infants is particularly sensitive to malnutrition.The growth and neural development of very low birth weight infants will be limited by various nutritional deficiencies.Early enteral nutrition is beneficial for the growth and neural development of very low birth weight infants.However,there is still a controversy about the timing of starting enteral nutrition,the amount of milk to be fed,the rate of adding milk and whether strengthening breast milk or adding probiotics.This article reviews the problems and controversy of enteral nutrition in very low birth weight infants.

Caracterización general de Lactarios de Hospitales de Referencia de Asunción y Departamento Central

Introducción: Los lactarios iniciaron sus actividades en los hospitales de nuestro medio, con el objetivo de contribuir al mantenimiento del estado nutricional y a la recuperación de la salud de los pacientes hospitalizados, a través de una intervención nutricional de excelencia técnica. Objetivo: Caracterizar los Lactarios de Hospitales de Referencia de Asunción y Central, durante el periodo 2014, para establecer un diagnóstico de la situación de adecuación de los mismos a las normas internacionales. Materiales y Métodos: Diseño descriptivo, observacional. Se utilizó una encuesta a partir del documento "Orientaciones técnicas para Servicios Dietéticos de Leche (SEDILE) y Central de Fórmula Enteral (CEFE) del Ministerio de Salud de Chile. Se realizó observación directa de los lactarios y encuesta a los profesionales encargados. Estadística: A cada variable de las dimensiones evaluadas en los lactarios se le asignó una puntuación de acuerdo a la presencia (1) o ausencia (0) de la característica estudiada y estos resultados se compararon al 100% de los datos del instrumento de recolección. Las variables obtenidas fueron cualitativas, dicotómicas (presencia o ausencia) y para su descripción se utilizó la distribución de frecuencia en porcentajes. Para las variables cuantitativas se utilizaron las medidas de tendencia central y dispersión. Resultados: Ingresaron al estudio siete lactarios de hospitales públicos, dos de los cuales fueron para extracción de leche materna. En relación a la disponibilidad de: 1) Recursos físicos: el porcentaje (%) global fue del 55% (rango 38-80%). 2) Equipamiento: el % global fue del 42% (rango 27-62%). 3) Manual de funciones y organigrama: el % global fue del 55% (rango 25-75%). 4) Normas y procedimientos: el % global fue del 59% (rango 27-80%). Conclusiones: La dimensión más afectada en los lactarios evaluados fue el equipamiento, seguida de recursos físicos y la disponibilidad de manual de funciones y organigrama.

Introduction: The lactary became active in Paraguayan hospitals to contribute to maintain or restore the nutritional health of hospitalized patients through nutritional intervention. Objetive: To characterize the lactary operating at reference hospitals in Asuncion and the Central Department, in 2014, to determine their adequacy to international standards. Materials and Methods: We conducted a descriptive and observational study by direct observation of the lactary and a survey, based on the guidelines of SEDILE (technical guidelines for dietary milk services) and CEFE (enteric formula center). Statistics: Each variable assessed by SEDILE criteria was assigned a point value according to the presence (1) or absence (0) of the particular criterion and compared to the total data collected in the survey. Variables determined were qualitative and binary (presence or absence), and described with percentage frequency distribution. Central tendency and dispersion measures were used for quantitative variables. Results: Seven lactary from public hospitals were included, of which two were dedicated to extraction of breast milk. Overall availability of physical resources was 55% (range 38-80%), of equipment, 42% (range, 27-62%), of organization charts and job description manuals, 55% (range, 25-75%), and standard and procedures manuals 59% (range, 27-80%). Conclusions: The greatest shortfall in the lactary studied was of equipment, followed by physical resources and organization and job function manuals.