Endotoxemia following enteral refeeding in children.

Plasma endotoxin-like activity, tumor necrosis factor alpha (TNFalpha) concentrations, core body temperature, and liver functions were measured before and after enteral feeding in children who had been deprived of enteral feeding for 5 days because of their illness. Transient endotoxemia and elevations in plasma TNFalpha concentrations occurred. Core body temperature, aspartate aminotransferase, alamine aminotransferase, and bilirubin concentrations were normal in patients who had elevated plasma endotoxin-like activity. Transient endotoxemia following enteral feeding may be due to the translocation from the gastrointestinal (GI) tract as a result of increased mesenteric circulation and peristalsis. No clinical consequences were noted despite transient endotoxemia. The transient endotoxemia is not due to the immature GI tract; instead, it results from enteral feeding following the deprivation of enteral feeds.

Transient central hypothyroidism as a cause of failure to thrive in newborns and infants.

The course of two neonates and one 4-month-old infant with laboratory and clinical evidence of central hypothyroidism is described. All three presented with failure to thrive and improved after L-T4 therapy. Early recognition and treatment of newborns and infants with central hypothyroidism is important to maximize the potential for growth and development. Two of the three infants have been documented to have transient central hypothyroidism of hypothalamic origin, not previously reported.

Erythromycin accelerates gastric emptying of indigestible solids and transpyloric migration of the tip of an enteral feeding tube in fasting and fed states.

Erythromycin has been shown to initiate gastric interdigestive migrating motor complexes, which are the motor events responsible for gastric emptying of indigestible solids. Hence, erythromycin should also accelerate gastric emptying of indigestible particles and facilitate transpyloric migration of the tip of an enteral feeding tube. Accordingly, we assessed the effect of erythromycin on these events, using a single-blind crossover study. Healthy subjects were nasally intubated with an enteral feeding tube. For fasting studies, the subjects remained fasted; in the fed studies, the subjects were fed a cheeseburger and fries after placement of the feeding tube. Then, ten 1-cm radiopaque plastic segments were swallowed by each subject, followed by an iv infusion of either erythromycin (200 mg over 20 min) or saline. Abdominal x-rays were then taken at regular intervals to document the location of the tube tip and the plastic segments. Erythromycin significantly shortened gastric emptying time of the indigestible particles during both fasting and fed states. Erythromycin also accelerated transpyloric migration of the tip of the feeding tube in both fasting and fed states. Hence, erythromycin can be beneficial when placement of a feeding tube in the small intestine is clinically desired.

Glucose, insulin, gastric inhibitory polypeptide, and pancreatic polypeptide responses to polycose during pregnancy.

Polycose, a glucose polymer produced by controlled acid enzyme hydrolysis of starch, has been proposed as an effective substitute for glucose solution in antepartum screening for glucose intolerance. The purposes of this study were to examine the glucose and hormonal responses to 50 g of glucose polymer (polycose) solution in pregnant and nonpregnant women and to compare these with the standard 50-g oral glucose challenge test. In addition, the subject's acceptance of the glucose polymer solution was evaluated. Subjects were examined after an overnight fast following a 3-day dietary preparation. There was no difference in glucose or insulin responses to glucose or polycose in either pregnant or nonpregnant women. In contrast, the gastric inhibitory polypeptide response to polycose was significantly higher than to glucose. No differences were observed in plasma pancreatic polypeptide responses to glucose and polycose. In the pregnant subjects, even though the plasma insulin response to carbohydrate challenge was higher than in the nonpregnant subjects, gastric inhibitory polypeptide levels were significantly lower. Patient satisfaction was similar with both carbohydrate solutions. These data suggest that polycose can be used as a substitute for glucose in antepartum testing, although the differences in the hormonal responses should be recognized. Further studies in a subject population with carbohydrate intolerance will be required before polycose use can be recommended in abnormal states.

Lack of glucose elevation after simulated tube feeding with a low-carbohydrate, high-fat enteral formula in patients with type I diabetes.

PURPOSE: Commercially available enteral formulas frequently cause hyperglycemia. This often leads to difficult and complex diabetes management with glucosuria and urinary losses of calories, fluid, and electrolytes. In this study, we compared a new product, EN-8715 (8% soluble fiber, 18% Polycose, 7% fructose, 50% fat, 17% protein), with a standard feeding product, Ensure HN (53% simple carbohydrates, 30% fat, 17% protein), to determine whether the new product would lower the glucose response. PATIENTS AND METHODS: Ten subjects (four women and six men) with type I diabetes were evaluated in paired, simulated tube feeding studies. After an overnight fast, a Biostator (artificial endocrine pancreas) was attached to each subject, and a steady-state blood glucose level of 150 mg/dL (8.4 mM) was established. The Biostator was then programmed to deliver a small basal amount of insulin (0.1 mU/kg/minute [718 pmol/kg/minute]), and the patients were given 20 mL of the randomly assigned formula every 15 minutes for 240 minutes (320 mL). Counterregulatory hormone responses to bringing the initial glucose response to the two enteral feeding formulas were measured and compared. RESULTS: The glucose response (mg/dL/four hours +/- SEM) essentially did not rise after EN-8715 (-2 +/- 33 mg/dL/four hours [-0.11 +/- 1.83 mM/four hours]) compared with that for Ensure HN (190 +/- 32 mg/dL/four hours [10.64 +/- 1.79 mM/four hours]). Urinary glucose losses (g +/- SEM) were significantly (p = 0.01) less after the new product (1.4 +/- 0.6 g [7.8 +/- 3.3 mmol] versus 5.7 +/- 1.5 g [30.2 +/- 8.3 mmol]). There were no significant differences in counterregulatory hormone responses. Side effects were minimal and product acceptance was similar. CONCLUSION: A low-carbohydrate, fiber-containing enteral feeding formula can limit hyperglycemia in patients with type I diabetes.

Nutrition support makes more than sense/cents.

Malnutrition is associated with an increased risk of both surgical and medical complications; for example, pre-operative nutritional status is predictive of post-operative morbidity and mortality. Such complications result in increased costs to patients and to the health care facility. Studies have shown that nutrition support is associated with fewer complications that can translate into fewer costs. For instance nutrition support is associated with a reduction in mortality, sepsis, hospitalization time and to improve tolerance to radiation therapy. Although more research is required, these studies suggest that indeed nutrition support makes more than sense and can make more than "cents" for the health care delivery system.

Reverse tri-iodothyronine to tri-iodothyronine ratio and gestational age.

The biologic significance of reverse tri-iodothyronine is not yet identified. Cord blood values reflect the fetal thyroid state, with rT3 excess and tri-iodothyronine deficiency. In an attempt to correlate thyroid function and gestational age, T3 and rT3 concentrations were measured by radioimmunoassay on 64 cord blood samples. Infant gestational ages ranged from 29 to 42 weeks; birth weights from 650 to 3,870 gm. The results show a significant positive correlation between gestational age and T3 and a significant negative correlation between gestational age and rT3. The rT3/T3 offers the best correlation.