Association between enteral feeding and gastrointestinal complications in children receiving extracorporeal life support: A retrospective cohort study.

BACKGROUND: Extracorporeal life support is an accepted treatment modality for children with severe cardiac and/or respiratory dysfunction. However, after a period of inadequate gut perfusion, clinicians are often reluctant to initiate enteral nutrition. METHODS: This was a retrospective cohort study in a single large pediatric intensive care unit in North West England over 5.5 years (2017-2022). RESULTS: One hundred fifty-six children, who had a median age of 2 months (IQR, 0.3-15) and a mean weight-for-age z score of -1.50 (SD, 1.7), were included. Indications for extracorporeal life support were respiratory failure (31%), cardiac arrest (28%), low cardiac output state (27%), and inability to separate from cardiopulmonary bypass (12%). Most (75%) children were fed during extracorporeal life support, with a median time to initiate feeding of 24 h (IQR, 12.2-42.7). More gastrointestinal complications were associated with being enterally fed (86% vs 14%; P < 0.001), but complications were predominantly feed intolerance (46%), which was associated with receiving formula feeds rather than maternal (breast) milk (P < 0.001). Overall, the proportion of children's median energy targets achieved by 72 h was 38% (IQR, 10.7%-76%), but this varied by support indication. CONCLUSIONS: Our findings suggest most children tolerated enteral feeding within 24 h after extracorporeal life support initiation, with only mild gastrointestinal complications.

A preliminary investigation of phonological encoding skills in children who stutter.

PURPOSE: The present study investigated phonological encoding skills in children who stutter (CWS) and those who do not (CNS). Participants were 9 CWS (M=11.8 years, SD=1.5) and 9 age and sex matched CNS (M=11.8 years, SD=1.5). METHOD: Participants monitored target phonemes located at syllable onsets and offsets of bisyllabic words. Performance in the phoneme monitoring task was compared to an auditory tone monitoring task. RESULTS: Repeated measures analysis of the response time data revealed significant Group×Task×Position interaction with the CWS becoming progressively slower than the CNS in monitoring subsequent phonemes located within the bisyllabic words; differences were not observed in the auditory tone monitoring task. Repeated measures analysis of the error data indicated that the groups were comparable in the percent errors in phoneme vs. tone monitoring. The CWS group was also significantly slower in a picture naming task compared to the CNS. CONCLUSIONS: Present findings suggest that CWS experience temporal asynchronies in one or more processes leading up to phoneme monitoring. The findings are interpreted within the scope of contemporary theories of stuttering. EDUCATIONAL OBJECTIVES: At the end of this activity the reader will be able to: (a) discuss the literature on phonological encoding skills in children who stutter, (b) identify theories of phonological encoding in stuttering, (c) define the process of phonological encoding and its implications for fluent speech, (d) suggest future areas of research in the investigation of phonological encoding abilities in children who stutter.

Safety behaviours preserve threat beliefs: Protection from extinction of human fear conditioning by an avoidance response.

A laboratory autonomic conditioning procedure was used to establish fear conditioning in human participants by pairing neutral stimuli with electric shock. Participants were also trained to make a button-press response to avoid shock. A target fear stimulus was then extinguished by presenting it without shock. The experimental group was given the opportunity to make the avoidance response during extinction whereas the control group was not. When the fear stimulus was tested without the response available, the control group showed normal extinction of both shock expectancy ratings and skin conductance responses, but the experimental group showed "protection from extinction": they continued to give high expectancy ratings and strong skin conductance responses. We interpret this effect as analogous to the role of within-situation safety behaviours in preserving threat beliefs during exposure therapy for anxiety disorders. The results support a cognitive account of learning and anxiety. The procedure provides a potential laboratory model for further examination of the cognitive and neural mechanisms underlying anxiety and its reduction.