The effect of early oral postoperative feeding on the recovery of intestinal motility after gastrointestinal surgery: a systematic review and meta-analysis of randomized clinical trials.

Background and aims: Postoperative ileus is a frequent condition, leading to complications and a longer hospital stay. Few studies have demonstrated the benefit of early oral feeding in preventing ileus after gastrointestinal surgery. This study aims to evaluate the efficacy of early versus delayed oral feeding on the recovery of intestinal motility, length of hospital stay, and complications. Methods: We conducted a systematic review and meta-analysis of randomized control trials, searching PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and the ClincalTrials.gov until 31 December 2022. We evaluated the first passage of the stool, the first flatus, complications, length of postoperative stay, and vomiting. We assessed the risk of bias using the Cochrane risk of bias tool (version 2) for randomized trials and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results: We included 34 studies with a median sample size of 102 participants. With a moderate certainty of the evidence, the early oral feeding may reduce the time taken for the first passage of the stool (MD -0.99 days; CI 95% -1.25, -0.72), the first flatus (MD -0.70 days; CI 95% -0.87, -0.53), and the risk of complications (RR 0.69; CI 95% 0.59-0.80), while with a low certainty of evidence, it may reduce the length of stay (MD -1.31 days; CI 95% -1.59, -1.03). However, early feeding likely does not affect the risk of vomiting (RR 0.90; CI 95% 0.68, 1.18). Conclusion: This review suggests that early oral feeding after gastrointestinal surgery may lead to a faster intestinal recovery, shorter postoperative stays, and fewer complications. However, careful interpretation is needed due to high heterogeneity and the moderate-to-low quality of evidence. Future studies should focus on the type and starting time of early oral feeding.

Early feeding and nutritional status of Portuguese children in the first 36 months of life: EPACI Portugal 2012-a national representative cross-sectional study.

Background: Early feeding practices have a critical role in the future not only in health but also in modulating eating habits. This study aimed to assess breastfeeding and complementary feeding practices and the nutritional status of Portuguese toddlers aged 0-36 months. Methods: EPACI Portugal 2012 is a cross-sectional study of a national representative sample. Trained interviewers collected data about early feeding practices and anthropometrics. Body mass index was classified according to World Health Organization criteria. Frequencies and survival analysis were used to characterize variables. Results: More than 90% of children were initiated breastfeeding, around 20% were exclusively breastfed for six months, and about 20% were breastfed at 12 months while complementary feeding was taking place. Exclusive breastfeeding was determined by maternal prepregnancy body mass index (HR 1.01; 95% CI 1.00, 1.03, P=.03) and low birth weight (HR 1.61; IC 95% 1.21, 2.15, P=.001) of the infants. About 90% were initiated complementary feeding between four and six months, and almost 10% were introduced to cow's milk before 12 months. In the second year of life, 83.2% and 61.6% of toddlers have already consumed nectars and sweet desserts, respectively. About one-third of Portuguese toddlers showed a body mass index z-score >1, and 6.6% were overweight/obese (z-score >2). No association was found between the duration of breastfeeding or timing of complementary feeding and the body mass index z-score in children. Conclusions: Despite the low prevalence of exclusive breastfeeding at six months, Portuguese infants effectively comply with dietary recommendations during the first year of life. The transition to the family diet must be carefully made. There is a high prevalence of Portuguese toddlers at least at overweight risk. The duration of breastfeeding or timing of complementary feeding was not associated with the expression of overweight/obesity.

Feeding strategy and prebiotic supplementation: Effects on immune responses and gut health in the early life stage of broiler chickens.

This study aimed to investigate the effects of early or late feeding strategies and prebiotic, on immune responses and gut health during the early life stage of broiler chickens. A total of 240 day-old male broiler chicks were used in a 2 × 3 factorial arrangement of treatments that comprised 2 feeding strategies (early or late) and 3 levels of prebiotic (0, recommended dosage or three times the recommended dosage) in a completely randomized design with 4 pen replicates and 10 broilers per each. Compared to broiler chickens that had early access to feed, delayed access to feed resulted in an increased population of Escherichia coli and a decreased population of Lactobacillus spp. and Bifidobacterium spp. in the ileum (P < 0.05). Additionally, delayed access to feed led to a decrease in villus height, crypt depth, villus height: villus width ratio, goblet cell density, and mucin 2 gene expression in the ileum (P < 0.05). The supplementation of prebiotics in both the late and early feeding strategy groups resulted in increased villus height, crypt depth, goblet cell density, mucin 2 gene expression, and antibodies against Infectious Bursal Disease (IBD). Additionally, it led to an improvement in the foot web thickness index (P < 0.05). Furthermore, it resulted in a significant decrease in the population of Escherichia coli, while the populations of Lactobacillus spp. and Bifidobacterium spp. in the ileum were significantly increased (P < 0.05). Therefore, this study suggests that incorporating prebiotics in the starter diet can effectively enhance immune responses and promote gut health, regardless of the feeding strategy (early or late). In conclusion, this study demonstrates the potential benefits of incorporating prebiotics into poultry diets to alleviate the detrimental effects of delayed access to feed and improve gut health during the early life stage of broiler chickens.

Early enteral nutrition versus early supplemental parenteral nutrition in patients undergoing major abdominal surgery: a secondary analysis of 2 randomized clinical trials.

BACKGROUND: The effect of early isoenergetic feeding routes [early enteral nutrition (E-EN) or early supplemental parenteral nutrition (E-SPN)] on the outcome of patients undergoing major abdominal surgery is controversial. OBJECTIVES: The aim of this study was to investigate the impact of early isoenergetic EN compared with early isoenergetic SPN on nosocomial infections in patients undergoing major abdominal surgery. METHODS: This study is a secondary, post hoc analysis of data from 2 open-label randomized clinical trials. Participants were recruited from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and with Nutritional Risk Screening 2002 score ≥3. All eligible patients were categorized into 2 groups based on their achievement of the 100% energy target on postoperative day (POD) 3: the E-EN group (n = 199) and the E-SPN group (n = 115). The primary outcome was the incidence of nosocomial infections between POD 3 and hospital discharge. RESULTS: In total, 314 patients [mean (SD) age, 59.2 (11.4) y; 113 (36.0%) females] were included. Patients in the E-EN group showed no significant difference in nosocomial infections compared with those in the E-SPN group {17/199 [8.5%] compared with 10/115 [8.7%], risk difference, 0.2% [95% confidence interval (CI): -6.3, 6.6]}. The hematological nutritional status of the E-EN group showed a significant improvement at discharge compared with the E-SPN group (albumin: 38.0 ± 6.0 g/L compared with 35.5 ± 7.6 g/L; mean difference, -2.5 g/L; 95% CI: -4.0, -1.0 g/L; prealbumin: 200.0 ± 8.0 mg/L compared with 158.4 ± 38.1 mg/L; mean difference, -41.6 mg/L; 95% CI: -41.7, -36.1 mg/L). Other indicators were comparable between groups. CONCLUSION: E-EN compared with isoenergetic SPN may not be associated with a reduced rate of nosocomial infection in patients undergoing major abdominal surgery, but may be associated with improved hematological nutritional status. TRIAL REGISTRATION NUMBER: This trial was registered at clinicaltrials.gov as NCT03115957 (https://clinicaltrials.gov/ct2/show/NCT03115957) and NCT03117348 (https://clinicaltrials.gov/ct2/show/NCT03117348).

Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta-analysis.

BACKGROUND: Traditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6-14 days post-operatively due to concern for orocutaneous fistula development. METHODS: Multiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed- and random-effects meta-analyses were used. RESULTS: One randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = -0.02, p = 0.06) or free flap failure (RD = -0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = -2.43, p < 0.01). CONCLUSIONS: While further prospective trials are necessary, initiation of oral intake before post-operative day 5 may be appropriate in properly selected patients following oral reconstruction.

A Comparative Study Between the Early and Late Enteral Nutrition After Gastrointestinal Anastomosis Operations.

INTRODUCTION: Intestinal anastomosis is a surgical procedure crucial for restoring the integrity of the digestive system and finds widespread application in addressing diverse gastrointestinal disorders such as tumors, inflammatory conditions, and traumatic injuries. The timing of restarting feeding after the surgery is a debated topic due to its potential impact on patient recovery. Early enteral feeding, administered soon after surgery, aims to counteract the negative effects of prolonged fasting and improve outcomes. OBJECTIVE: This study analyzed the early and late enteral feeding following gastrointestinal anastomosis surgery. METHODS: Forty patients undergoing abdominal surgery were prospectively randomized into early or late feeding groups. Demographics, laboratory values, operative time, blood loss, transfusion rates, nasogastric tube (NGT) removal, hospital stay, gastrointestinal recovery, postoperative body mass index (BMI), and complications were compared. Data was organized in Excel and analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk, NY). Qualitative data were presented with numbers and percentages, while parametric quantitative data used means, standard deviations, and ranges. Non-parametric quantitative data were represented with medians and interquartile ranges. Chi-square tests were used for comparing two qualitative groups with predicted counts less than 5, while independent t-tests and Mann-Whitney tests were employed for comparing two quantitative groups with parametric and non-parametric distributions, respectively. The analysis used a 95% confidence interval, a 5% margin of error, and considered P values less than 0.05 as significant. RESULTS: Early feeding was associated with significantly shorter NGT removal times (p=0.005) and hospital stays (p=0.001) than late feeding. Postprandial potassium levels were higher in the early group (p=0.007), while CRP levels were significantly lower (p=0.004). No significant differences were found in operative time, blood loss, transfusion rates, gastrointestinal recovery, postoperative BMI, or complication rates between groups. CONCLUSIONS: Early enteral feeding appears safe and effective after gastrointestinal anastomosis surgery, potentially reducing hospital stay and improving inflammatory markers without increasing adverse events.

Impact of early posthatch feeding on the immune system and selected hematological, biochemical, and hormonal parameters in broiler chickens.

Under commercial conditions, chicks hatch within a 24 to 48 h window, a period known as the hatching window. Subsequently, they undergo various treatments before finally being transported to the broiler farm. These procedures may delay the chicks' access to food and water, sometimes receiving them as late as 72 h after hatching. Previous studies have indicated that fasting during this initial period is detrimental, leading to impaired body growth, compromised immune system response, and hindered muscle development. The objective of this study was to assess the impact of early posthatch feeding on immune system organs and selected hematological, biochemical, and hormonal parameters. The experiment utilized Ross 308 broiler eggs incubated under typical commercial hatchery conditions. The experimental group's eggs were hatched in HatchCare hatchers (HC) with immediate access to feed and water, while the control group's eggs were hatched under standard conditions (ST). Thirty chickens from each group were assessed on the 1st (D1), 7th (D7), 21st (D21), and 35th (D35) day after hatching. On D1, the HC group exhibited lower hemoglobin, hematocrit, and total serum protein values, suggesting that early access to water prevents initial dehydration in newborn chicks. Conversely, the ST group showed a stress reaction on D1 due to feed deprivation, leading to an almost 2-fold higher serum corticosterone concentration compared to the HC group. However, this increase did not result in a significant change in the heterophil/lymphocyte ratio. Furthermore, the HC group displayed an increase in triglyceride concentration and a decrease in HDL concentration on D1. On D7, the HC group exhibited an increased relative weight of the bursa and a higher CD4+ cell number in the cecal tonsil (CT), indicating a more rapid development of these organs resulting from early stimulation of the gastrointestinal tract. However, early feeding did not influence the numbers of Bu-1+, CD4+, and CD8+ cells or the germinal center (GC) areas in the spleen. In conclusion, early feeding contributes to the welfare of newborn chicks by reducing dehydration and stress levels and stimulating the development of gut-associated lymphoid tissue.

An Open-label Randomized Controlled Trial of Early Initiation of Nasogastric Feeding After Endotherapy in Variceal Bleeding: A Proof-of-concept Study.

Background and aims: Limited data exist on the safety of early nasogastric (NG) feeding in patients with cirrhosis after endotherapy for variceal bleeding (VB). We studied the impact of early NG tube feeding in these patients in this proof-of-concept open-label randomized controlled trial. Methods: Eligible patients with cirrhosis undergoing endotherapy for VB were randomized to receive either a liquid diet through a 14 Fr NG tube (commencing 1 h after endotherapy) (early feeding [EF] group) or sips of water and lemon water orally (standard-of-care [SOC] group) for total duration of 48 h. The primary outcome was 5-day rebleeding in both arms. Other outcomes included 5-day infection rate, hepatic encephalopathy during hospitalization, and 6-week mortality. Results: Eighty patients (Mean age: 41 ± 11.5 years; males [82.5%]; alcohol etiology [55%]) were included. Baseline median Child-Pugh and MELD scores were similar (CTP: 8 [IQR: 8-9] vs 9 [8-9.25]; P = 0.47 and MELDNa: 13 [10.75-16.25] vs 15 [12-18.25]; P = 0.16). The 5-day rebleeding rates in EF and SOC groups were 2.5% and 5%, respectively (P = 0.55), and non-inferiority or superiority of either could not be demonstrated. The incidence of infection (2.5% [EF] vs 2.5% [SOC]; P = 1.00) and development of HE (5% [EF] vs 2.5% [SOC]; P = 0.36) during hospitalization were comparable. The average daily calorie and protein intake in the EF group during the 48 h was 1318 ± 240 Kcals and 43.4 ± 9.2 g of proteins. No patient in the EF group had feed intolerance. Conclusion: Early initiation of NG tube-based feeding after endotherapy in VB appears safe and well tolerated without the additional risk of rebleeding or encephalopathy.

Effects and Interactions of Incubation Time and Preplacement Holding Time on Mortality at Placement, Yolk Sac Utilization, Early Feeding Behavior and Broiler Live Performance.

The effects and interactions of incubation time and chick preplacement holding time on mortality at placement, utilization of yolk sac, crop filling rate, early feeding-drinking behavior, and broiler live performance were investigated. Ross 308 broiler hatching eggs from a 39-week-old flock were set in two identical setters in a commercial hatchery, with the setting time 12 h earlier in one machine. At the end of incubation, chicks were removed from the hatchers at the same time. Thus, the incubation times were either 504 h (normal incubation time (NIT) treatment) or 516 h (longer incubation time (LIT) treatment). After the pull time, chicks from each incubation time group were subjected to either 6, 24, 48, 60, or 72 h preplacement holding times. At placement, chicks were given access to feed and water. In total, 19,200 chicks were randomly assigned to a total of 10 subtreatment groups (2 incubation times × 5 preplacement holding times). Therefore, a total of 1920 chicks were used in each subtreatment group for the grow-out period in a commercial broiler house. For the first week of the experiment, 160 randomly selected as-hatched (not sexed) chicks were placed in 12 replicate floor pens (120 total pens). From the second week of age onward, chicks from two pens were combined into six replicate pens, with 320 chicks per replicate (60 total pens). An interaction was found between incubation time and preplacement holding time for residual yolk sac (RYS) weight (g, %) (p < 0.001). RYS weight was greater at pull time and at 6 and 24 h of preplacement holding in the NIT treatment compared to the LIT treatment, while differences were no longer evident at 48-72 h. The lowest percentage of chicks with full crops and eating activity was observed in the shortest preplacement holding time (6 h) group at 3 h after placement. As expected, the initial BW at placement clearly decreased with increasing duration after the pull time (p < 0.05), with the highest and lowest weights found in the 6 and 72 h holding time treatments, respectively. This BW difference was still evident at 35 d after placement and chicks held for the longest period after the pull time (72 h) showed the lowest BW (p < 0.001). However, there was no significant difference between the 6 and 60 h preplacement holding times. Mortality during the first 7 d after placement increased only when the preplacement holding time was extended to 72 h (p = 0.031). Similarly to the 7 d results, chicks held for 72 h exhibited higher 0-35 day mortality compared to those held for 6 or 24 h (p = 0.028). Neither BW nor mortality was affected by incubation time treatment at 35 d after placement (p > 0.05). It can be concluded that there were no significant differences in average BW and mortality, up to and including a 60 h holding time under thermal comfort conditions, but a 72 h preplacement holding time resulted in final BW and mortality being negatively affected. In addition, LIT tended to have a beneficial effect on BW and mortality compared to NIT when the preplacement holding time was shorter (6-24 h) but had a negative effect for extended holding times (48-72 h).

Outcomes of Early Oral Feeding Compared to Delayed Feeding in Children after Elective Distal Bowel Anastomosis.

Background: Conventionally, oral feeds after distal bowel anastomosis surgery (ileostomy/colostomy closure) are delayed until after bowel peristalsis is established. The safety of an early feeding regimen is not established in children. This study compared early feeding regimens with delayed feeding in children undergoing elective intestinal anastomosis surgeries. Materials and Methods: In this retrospective multicentric cohort study, children undergoing elective distal bowel anastomosis surgery were divided into Group A (oral feeds allowed within 6 h) and Group B (delayed feeds). The two groups were compared for the incidence of abdomen distension, vomiting, surgical site infection, duration of analgesia, length of hospital stay, and readmission rate. Results: During the study, 58 patients were included: Group A (n = 26) and Group B (n = 32). The duration of analgesia (1.9 vs. 4.01 days) and length of hospital stay (3.38 vs. 5.0 days) were significantly less in Group A. Abdominal distension (7.7% vs. 15.6%), vomiting (11.5% vs. 15.6%), surgical site infection rate (3.8% vs. 12.5%), and readmissions (0% vs. 3.1%) were less in Group A, but statistically not significant. Conclusion: Early feeding after the elective restoration of distal bowel continuity can be safely practiced in the pediatric population. It is associated with a reduced need for analgesia and shorter hospital stay.

Early feeding reduces length of hospital stay in patients with acute lower gastrointestinal bleeding: A large multicentre cohort study.

AIM: No studies have compared the clinical outcomes of early and delayed feeding in patients with acute lower gastrointestinal bleeding (ALGIB). This study aimed to evaluate the benefits and risks of early feeding in a nationwide cohort of patients with ALGIB in whom haemostasis was achieved. METHODS: We reviewed data for 5910 patients with ALGIB in whom haemostasis was achieved and feeding was resumed within 3 days after colonoscopy at 49 hospitals across Japan (CODE BLUE-J Study). Patients were divided into an early feeding group (≤1 day, n = 3324) and a delayed feeding group (2-3 days, n = 2586). Clinical outcomes were compared between the groups by propensity matching analysis of 1508 pairs. RESULTS: There was no significant difference between the early and delayed feeding groups in the rebleeding rate within 7 days after colonoscopy (9.4% vs. 8.0%; p = 0.196) or in the rebleeding rate within 30 days (11.4% vs. 11.5%; p = 0.909). There was also no significant between-group difference in the need for interventional radiology or surgery or in mortality. However, the median length of hospital stay after colonoscopy was significantly shorter in the early feeding group (5 vs. 7 days; p < 0.001). These results were unchanged when subgroups of presumptive and definitive colonic diverticular bleeding were compared. CONCLUSION: The findings of this nationwide study suggest that early feeding after haemostasis can shorten the hospital stay in patients with ALGIB without increasing the risk of rebleeding.

Early enteral nutrition is associated with improved outcomes in critically ill mechanically ventilated medical and surgical patients.

BACKGROUND AND AIMS: Data suggest that guidelines for enteral nutrition (EN) initiation are not closely followed in clinical practice. In addition, critically ill mechanically ventilated (MV) patients have varying metabolic needs, which often increase and persist over time, requiring personalized nutrition intervention. While both over- and under-nutrition can impact patient outcomes, recent data suggest that targeted early EN delivery may reduce mortality and improve clinical outcomes. This study examined if early EN improves clinical outcomes and decreases costs in critically ill patients on MV. METHODS: Data from a nationwide administrative-financial database between 2018 and 2020 was utilized to identify eligible adult critical care patients. Patients who received EN within 3 days after intubation (early EN) were compared to patients who started EN after 3 days of intubation (late EN). Outcomes of interest included hospital mortality, discharge disposition, hospital and intensive care unit (ICU) length of stay (LOS), MV days, and total cost. After inverse-probability-of-treatment weighting, outcomes were modeled using a nominal logistic regression model for hospital mortality and discharge disposition, a linear regression model for cost, and Cox proportional-hazards model for MV days, hospital and ICU LOS. RESULTS: A total of 27,887 adult patients with early MV were identified, of which 16,772 (60.1%) received early EN. Regression analyses showed that the early EN group had lower hospital mortality (OR = 0.88, 95% CI, 0.82 to 0.94), were more likely to be discharged home (OR = 1.47, 95% CI 1.38 to 1.56), had fewer MV days (HR = 1.23, 95% CI, 1.11 to 1.37), shorter hospital LOS (HR = 1.43, 95% CI, 1.33 to 1.54) and ICU LOS (HR = 1.36, 95% CI, 1.27 to 1.46), and lower cost (-$21,226; 95% CI, -$23,605 to -$18,848) compared to the late EN group. CONCLUSIONS: Early EN within 3 days of MV initiation in real-world practice demonstrated improved clinical and economic outcomes. These data suggest that early EN is associated with decreased hospital mortality, increased discharge to home, and decreased hospital and ICU LOS, time on MV, and cost compared to delayed initiation of EN; highlighting the importance of early EN to optimize utcomes ando support the recovery of critically ill patients on MV.

Feasibility of Enhanced Recovery after Surgery in Pediatric Colostomy Reversal.

Aim: Enhanced recovery after surgery (ERAS) are multimodal perioperative pathways that have shown improved outcomes. ERAS after colostomy reversal has shown promising results in adults and few pediatric studies. We report our experience using ERAS for a colostomy reversal. Materials and Methods: A retrospective analysis of children in whom ERAS was used during colostomy reversal between May 2016 and 2019 was carried out. ERAS protocol in our study included avoiding mechanical bowel preparation (MBP), oral liquid diet upto 3 h preoperatively, usage of regional anesthesia, minimal handling of bowel intraoperatively, using nonopioid analgesics for pain relief, early initiation of feeding on the first postoperative day, early discharge once full feeds are established. Outcomes analyzed are the duration of hospital stay and complications, including readmissions. Requirement for opioids and anti-emetics are noted. The outcomes are compared with traditional care pathways (TCP), which use MBP, overnight fasting, opioid analgesia, and delayed feeding. A total of 48 are included in the study, with 13 cases using ERAS and TCP in 35 cases. Statistical Analysis Used: Nonparametric Mann-Whitney U-test was used. Results: In the ERAS group, the mean length of hospital stay (LOS) postoperatively was 3.7 days (2-5 days) as opposed to 7.2 days (5-11 days) in TCP. There was only one child with complications in the ERAS group, while 9 cases in TCP had complications, though none of them required operative intervention. There was the requirement of anti-emetic in only one child in the ERAS group. Conclusion: ERAS for colostomy reversal is feasible in the pediatric population. For successful implementation, all personnel involved in the care of the child need to be educated about the protocol. It reduces LOS and complications.

The Effect of Early Feeding and Transporting Time from Hatcher to Farm On the Productive Performance and Carcass Traits of Broiler Chickens.

New researches suggest that an early feeding approach has a long-term influence on chick growth performance and nutrient metabolism. The present study was designed to determine the effect of early feeding and the time of chickens transferring from the hatchery to the field on broiler chickens' productive performance and carcass traits. Two hundred twenty-five chickens, one-day-old of broiler chickens Ross 308 with a mean live body weight of 45 g, were used and were randomly distributed to five treatments by 45 chickens per treatment with three replicates (15 chickens per replicate). The experimental treatments were as follows: T1 (control treatment) - the chickens were transferred 24 hours after hatching to the field without feeding, and in groups T2 to T5, the chickens were fed immediately and transferred to the field 24, 6,12,18 hours after hatching, respectively. The current results showed no significant (P>0.05) effects of the experimental treatments on final body live weight, weight gain, feed intake, and feed conversion ratio. In addition, the treatments' insignificant (P>0.05) effects on the weights of the carcass, abdominal fat, breast, thigh, back, wing, neck, heart, liver, and gizzard were found. It can be concluded that there was no evidence of a positive effect of early feeding and transporting duration after hatching on productive performance and carcass characteristics of broilers.

Host genotype affects endotoxin release in excreta of broilers at slaughter age.

Host genotype, early post-hatch feeding, and pre- and probiotics are factors known to modulate the gut microbiome. However, there is a knowledge gap on the effect of both chicken genotype and these dietary strategies and their interplay on fecal microbiome composition and diversity, which, in turn, can affect the release of endotoxins in the excreta of broilers. Endotoxins are a major concern as they can be harmful to both animal and human health. The main goal of the current study was to investigate whether it was possible to modulate the fecal microbiome, thereby reducing endotoxin concentrations in the excreta of broiler chickens. An experiment was carried out with a 2 × 2 × 2 factorial arrangement including the following three factors: 1) genetic strain (fast-growing Ross 308 vs. slower growing Hubbard JA757); 2) no vs. combined use of probiotics and prebiotics in the diet and drinking water; and 3) early feeding at the hatchery vs. non-early feeding. A total of 624 Ross 308 and 624 Hubbard JA757 day-old male broiler chickens were included until d 37 and d 51 of age, respectively. Broilers (N = 26 chicks/pen) were housed in a total of 48 pens, and there were six replicate pens/treatment groups. Pooled cloacal swabs (N = 10 chickens/pen) for microbiome and endotoxin analyses were collected at a target body weight (BW) of 200 g, 1 kg, and 2.5 kg. Endotoxin concentration significantly increased with age (p = 0.01). At a target BW of 2.5 kg, Ross 308 chickens produced a considerably higher amount of endotoxins (Δ = 552.5 EU/mL) than the Hubbard JA757 chickens (p < 0.01). A significant difference in the Shannon index was observed for the interaction between the use of prebiotics and probiotics, and host genotype (p = 0.02), where Ross 308 chickens with pre-/probiotics had lower diversity than Hubbard JA757 chickens with pre-/probiotics. Early feeding did not affect both the fecal microbiome and endotoxin release. Overall, the results suggest that the chicken genetic strain may be an important factor to take into account regarding fecal endotoxin release, although this needs to be further investigated under commercial conditions.

Group level and individual activity of broiler chickens hatched in 3 different systems.

Information on the behavior of chickens hatched in different systems is limited and inconsistent across different studies. Changes in broiler activity can be measured automatically and continuously. The aim of this study was to assess the effects of 3 hatching systems on flock activity using a commercial tracking system, and to compare these findings to individual activity measured under experimental conditions. As this experiment was part of a larger study, it was possible to investigate the effects of vaccination on individual activity. In study 1, flock activity was measured in chickens that hatched either conventionally in the hatchery (HH), in a system which provided nutrition in the hatcher (HF), or on-farm (OH). Chickens were reared in 2 batches, in 12 pens/batch (1,155 animals/pen). One camera recorded top-view images of each pen. A daily activity index (moved pixels/total pixels × 100) was calculated by automated image analysis. In study 2, individual activity was measured under experimental conditions using an ultra-wideband (UWB) system. Chickens from the 3 hatching systems were reared in 3 pens (1 pen/treatment, 30 animals/pen). At d14, UWB-tags were attached to 5 chickens/pen, which tracked the distances moved (DM). In study 1, group level activity showed a significant age × hatching system interaction (F8,752= 5.83, P < 0.001). HH and HF chickens showed higher activity levels than OH chickens in wk 1, 4, and 5. In wk 3, higher activity levels were measured in HH compared to HF, and in HF compared to OH pens. In contrast, HH chickens in small groups in study 2 showed lower DM than HF and OH chickens in wk 3 (P < 0.001). DM did not differ between treatments before vaccination, however, thereafter, HH chickens showed longer DM, whereas HF and OH chickens moved less. The results indicate that hatching system affected broiler activity at specific ages. Effects found at flock level could not be reproduced by individual measurements in study 2, although stocking density was comparable.

Immediate vs on-demand maternal oral full feeding after unplanned cesarean section during labor: a randomized controlled trial.

BACKGROUND: The adoption of Enhanced Recovery After Cesarean is increasing, but evidence supporting individual interventions having a specific benefit to Enhanced Recovery After Cesarean is lacking. A key element in Enhanced Recovery After Cesarean is early oral intake. Maternal complications are more frequent in unplanned cesarean delivery. In planned cesarean delivery, immediate full feeding enhances recovery, but the effect of unplanned cesarean delivery during labor is not known. OBJECTIVE: This study aimed to evaluate immediate oral full feeding vs on-demand oral full feeding after unplanned cesarean delivery in labor on vomiting and maternal satisfaction. STUDY DESIGN: A randomized controlled trial was conducted in a university hospital. The first participant was enrolled on October 20, 2021, the last participant was enrolled on January 14, 2023, and follow-up was completed on January 16, 2023. Women were assessed for full eligibility on arrival at the postnatal ward after their unplanned cesarean delivery. The primary outcomes were vomiting in the first 24 hours (noninferiority hypothesis and 5% noninferiority margin) and maternal satisfaction with their feeding regimen (superiority hypothesis). The secondary outcomes were time to first feed; food and beverage quantum consumed at first feed; nausea, vomiting, and bloating at 30 minutes after first feed, at 8, 16, and 24 hours after the operation, and at hospital discharge; parenteral antiemetic and opiate analgesia use; first breastfeeding and satisfactory breastfeeding, bowel sound, and flatus; second meal; cessation of intravenous fluid; removal of a urinary catheter; urination; ambulation; vomiting during the rest of hospital stay; and serious maternal complications. Data were analyzed using the t test, Mann-Whitney U test, chi-square test, Fisher exact test, and repeated measures analysis of variance as appropriate. RESULTS: Overall, 501 participants were randomized into immediate or on-demand oral full feeding (sandwich and beverage). Vomiting in the first 24 hours were reported by 5 of 248 participants (2.0%) in the immediate feeding group and 3 of 249 participants (1.2%) in the on-demand feeding group (relative risk, 1.7; 95% confidence interval, 0.4-6.9 [0.48%-8.28%]; P=.50), and the maternal satisfaction scores from 0 to 10 were 8 (6-9) for the immediate feeding group and 8 (6-9) for the on-demand feeding groups (P=.97). The times from cesarean delivery to the first meal were 1.9 hours (1.4-2.7) vs 4.3 hours (2.8-5.6) (P<.001), first bowel sound 2.7 hours (1.5-7.5) vs 3.5 hours (1.8-8.7) (P=.02), and second meal 7.8 hours (6.0-9.6) vs 9.7 hours (7.2-13.0) (P<.001). These intervals were shorter with immediate feeding. The participants were more likely to agree to recommend immediate feeding to a friend (228 [91.9%] in the immediate feeding group vs 210 [84.3%] in the on-demand feeding group; relative risk, 1.09; 95% confidence interval, 1.02-1.16; P=.009). However, at first feed for food, ate "nothing at all" rates were 10.4% (26/250) in the immediate group and 3.2% (8/247) in the on-demand group, and "eaten all" rates were 37.5% (93/249) in the immediate group and 42.8% (106/250) in the on-demand group (P=.02). Other secondary outcomes were not different. CONCLUSION: Compared with on-demand oral full feeding, immediate oral full feeding after unplanned cesarean delivery in labor did not increase the maternal satisfaction score and was not noninferior on postoperation vomiting. On-demand feeding with its emphasis on patient autonomy could be preferred, but the earliest full feeding should be encouraged and provided.

Effect of IOF and its interaction with post-hatch feeding procedure on hatchability, some organs development and post-hatch performance in broiler chickens.

BACKGROUND: Under commercial conditions, chickens are fasted for the first 36 to 72 h post-hatch. Delayed access to feed and water causes delayed development of the intestinal tract and retarded performance. OBJECTIVES: This study focused on the chick's life as affected by in ovo feeding (IOF) and the animal's interaction with the feeding procedure. The birds in a factorial arrangement (2 × 3) were placed into six treatment groups in a completely randomised design. The treatment groups differed in feed procedure, 6 h [early feeding (EF)] or 36 h [common feeding (CF)] post-hatch, with or without IOF with beta-hydroxy-beta-methyl butyrate (HMB) or calcium gluconate (CG) in a saline solution, and were examined for hatchability and performance parameters until 24 h post-hatch. In addition, physical and histological characteristics of breast, jejunum and serum indices in 14 days post-hatch and performance criteria until 35 days of age were recorded. METHODS: On day 17 of the incubation period, eggs were subjected to the IOF procedure. One mL of sterile IOF solution including 0.1% HMB or 0.4% CG dissolved in 5% saline solution was injected into the eggs. RESULTS: Results showed that IOF groups had lower (p < 0.05) FCR than the control group. The highest mortality rate was noted in the control-CF group. The lowest myofibril density was related to the HMB-CF group. Myofibril periphery, area and diameter for the HMB-CF group were larger (p < 0.05) than those of the other groups. CONCLUSIONS: Results indicated that injection of HMB increased hatchability by almost 15%. The IOF of HMB improved the digestive tract and breast muscle development and improved FCR.

Advances in acute and chronic pancreatitis.

Acute pancreatitis (AP) and chronic pancreatitis are the third leading gastrointestinal causes for admissions and readmissions to hospitals in the United States. This review of articles published between 2019-2022 (December) from international sources identified four categories of crucial new findings: The report includes (1) New genetic pathogenic mutations (TRPV6); expected genetic outcomes in a Northern European population; (2) a new serum diagnostic marker for AP-fatty acid ethyl esters-distinguishing acute pancreatitis associated with alcohol; explanations of the impact of monocytes/macrophages on the inflammatory process that defines their future in diagnosis, staging, and treatment; (3) innovations in timing of per os low-fat, solid food intake immediately on admission; resolution of concepts of aggressive parenteral fluid intake; dramatic shifts to non-operative from operative treatment of infected pancreatic necrosis. Each modification reduced interventions, complications, and lengths-of-stay; and (4) authoritarian recommendations for medical treatment of chronic pain. These advances offer opportunities to initiate newly proven treatments to enhance outcomes, alter the natural history, and envision the future of two diseases that have no known cure.

Research Note: Responses of broiler chickens to in ovo feeding with clove and cinnamon extract under hot-humid environments.

An experiment was carried out to evaluate the responses of broiler chickens to in ovo injection of aqueous extracts of clove and cinnamon under a hot-humid environment. The study involved the use of seven hundred hatching eggs from broilers (Ross 308) which were incubated with the use of standard protocol (37.8°C). The incubating eggs (100 each) were randomly selected and assigned to 7 treatments on day 17.5 of incubation, viz.: un-injected eggs (UE), eggs injected with 0.5 mL distilled water (DW), 2 mg clove (CL2), 4 mg clove (CL4), 2 mg cinnamon (CN2), 4 mg cinnamon (CN4), and 3 mg ascorbic acid (AA).Data on physiological parameters, hatchability, chick quality, and anatomical characteristics of the chicks were collected and analyzed using one-way analysis of variance. The results obtained revealed that the hatchability of eggs of AA and CN2 was higher compared to DW and UE. However, the hatchability of DW and UE was higher than those of CN4. The total chick quality scores of the control were similar to the other groups. Chick weights at hatch were similar in CL2, CN2, and AA but heavier than CN4, CL4, UE, and DW. The chick-to-egg ratio in AA was comparable to CL2 and CN2 but higher than UE, DW, CN4, and CL4. Total scores for chick quality of AA birds were similar to those of UE, CL2, and CL4 birds but higher than DW, CN2, and CN4 birds.