Blenderized food tube feeding in very young pediatric patients with special healthcare needs.

BACKGROUND: Up to 85% of children with severe developmental disabilities have feeding disorders and require enteral tube feeding. Many caregivers desire blenderized tube feeding (BTF) instead of commercial formula (CF) for their child, citing a desire for a more physiologic feeding, to reduce gastrointestinal (GI) symptoms and/or promote oral intake. METHODS: In this retrospective, single-center study, medical records (n = 34) of very young children (aged ≤36 months) with severe developmental disabilities were reviewed. Comparisons of growth parameters, GI symptoms, oral feeding, and GI medication use were made between the initial introduction of BTF and again at the last patient encounter when the children aged out of the program. RESULTS: Of the 34 charts reviewed (16 male and 18 female patients), comparisons between baseline BTF introduction and the last patient encounter indicated reductions in adverse GI symptoms, significant GI medication reduction (P = 0.000), increased oral food intake, and nonsignificant improvements in growth parameters. These positive outcomes were realized whether children received full or partial BTF or type of BTF formulation. CONCLUSION: Consistent with similar research studies, transitioning very young children with significant special healthcare needs from CF to BTF resulted in improvement in GI symptoms, reduced need for GI medications, supported growth goals, and contributed to improved oral feeding.

Low risk for microbial contamination of syringe and tube feeding bag surfaces after multiple reuses with home blenderized tube feeding.

BACKGROUND: Guidelines for the reuse of enteral tube feeding (ETF) equipment guidelines are limited to manufacturer recommendations. ETF equipment reuse studies are needed as the enteral population has increased, along with blenderized tube feeding (BTF). METHODS: This experiment tested microbial contamination of a reusable gravity feeding bag and syringe after 15 BTF reuses and cleanings. Eight bags and syringes were filled with the BTF, held at room temperature for 20 min, and then emptied, washed, and air dried. After the last air drying, the inner surfaces of the bag and syringe were swabbed, and aerobic microbial counts were performed using serial dilutions and plate counts. RESULTS: The microbial counts for all syringes and six bags were <1 colony-forming unit (CFU)/cm2 ; one bag was <5 CFU/cm2 and one bag was 12.5 CFU/cm2 . No legal guidelines for surface cleanliness exist for the food sector. Several studies propose a safe microbial level to be <2.5 CFU/cm2 , and the European Commission recommended <10 CFU/cm2 . Based on these proposed guidelines, microbial counts of all syringes and seven bags were within the proposed guidelines, except for one bag just above 10 CFU/cm2 . CONCLUSION: The feeding bag used in this study may be used multiple times for BTF with a reduced risk of microbial contamination when manufacturer's cleaning guidelines are followed. Although bolus tube feeding is an off-label use for syringes, they are frequently used for BTF, and in this study the cleaning after 15 uses over 5 days was effective to reduce microbial counts.

Blenderized food tube feeding in patients with head and neck cancer.

BACKGROUND: Patients with headand neck cancer (HNC) are at high risk for malnutrition before and during chemoradiation treatment. Many will also require tube feeding to address declines in energy intake, weight, and quality of life (QOL) caused by the impact of treatment on gastrointestinal (GI) symptoms. Blenderized tube feeding (BTF) may ameliorate these adverse conditions. METHODS: In this open-label, prospective pilot study, 30 patients with HNC who required feeding tube placement were recruited to switch from standard commercial formula after 2 weeks to a commercially prepared BTF formula. Weight, body mass index (BMI), GI symptoms, and QOL scores were tracked for 6 weeks from the first week of feeding tube placement. RESULTS: Of the 16 patients who completed the 6-week assessment period, weights and BMI scores for 15 patients trended upward. For most patients, QOL and oral intake increased and GI symptoms decreased over the 6-week period, particularly during weeks 3 and 4, when the impact of treatment is particularly exacting on patients with HNC. CONCLUSION: BTF effectively mitigated weight loss, GI symptoms, QOL scores, and total energy intake in this group of patients with HNC who received tube feeding for 6 weeks.

Accepted Safe Food-Handling Procedures Minimizes Microbial Contamination of Home-Prepared Blenderized Tube-Feeding.

BACKGROUND: The number of patients requiring home enteral nutrition (HEN) continues to increase. Many of these patients are interested in using blended food instead of, or in addition to, commercial enteral formula (CEF). Increased risk of food-borne illness is a concern of blenderized tube-feeding (BTF). This project assessed a standard procedure for minimizing bacterial growth of BTF prepared in the home setting. METHODS: Fifty participants prepared BTF in their kitchens using a standard preparation procedure to minimize bacterial contamination. BTF was assessed for growth of aerobic microorganisms, Escherichia coli, Staphylococcus aureus, and coliforms at baseline, 24-hour, and 48-hour intervals after preparation for a total of 150 colony forming units (CFU) counts performed. RESULTS: No sample had zero aerobic microbial counts; yet no substantial increase in microbial counts was observed during the 48 hours. At baseline and 24 hours, 5/50 (10%) had a CFU count of >104 , and at 48 hours, 6/50 (12%) exceeded 104 CFUs. Out of 150 CFU counts, 2 (1.3%) were just over 105 CFU/mL. Samples exceeding 104 CFU/mL were likely contaminated by common endospore-forming bacteria found in soil or by bacteria in milk that was close to its expiration date. CONCLUSION: In this study, 88% of the samples met the US Food Code criteria for safe food consumption; 10.7% met guidelines for marginal safety by other standards; and 1.3% slightly exceeded 105 CFUs. Established safe food-handling procedures can minimize bacterial contamination of BTF and consequently reduce risk of food-borne infection in HEN patients.

Addressing Frequent Issues of Home Enteral Nutrition Patients.

The home enteral nutrition (HEN) population is a medically diverse group whose number has increased substantially in recent decades. Although medically stable compared with acute care patients requiring nutrition support, HEN population needs are unique and require a team approach to manage nutrition. Frequently encountered issues by the HEN team include mechanical issues of the tube site, gastrointestinal and metabolic problems, and patient preferences regarding tube weaning, formula selection, and compliance. A thorough search of the published literature on how to manage these issues was conducted using scientific healthcare databases with the following inclusion criteria: English only, last 10 years, and reviews and clinical trials. Where appropriate, references from the retrieved articles were hand-searched for relevant articles older than 10 years and cited in this review. The purpose of this review is to provide the HEN team with strategies to address the top issues of home enteral feeding.

Comparison of Microbial Growth Between Commercial Formula and Blenderized Food for Tube Feeding.

BACKGROUND: Many healthcare facilities and providers prohibit blenderized tube feeding (BTF) for patients who request it due to concerns of high microbial load. The current project compared microbial loads of a standard ready-to-feed polymeric commercial formula (CF), a BTF made using baby food (BTF-BF), and a BTF prepared from blending whole food (BTF-WF), following food safety standards expected of U.S. hospitals. METHODS: Three tube-feeding formulas (CF, BTF-BF, BTF-WF) were prepared in a U.S. hospital and delivered in vitro to an unoccupied patient room. Samples were collected at zero hour, 2 hours, and 4 hours and compared for growth of aerobic microorganisms, Staphylococus aureus, coliforms, and Escherichia coli. The experiment was conducted in triplicate, 1 week apart. RESULTS: No S. aureus or coliform/E. coli were detected at any time point following preparation, and total bacterial count was well below acceptable limits. All 3 feeding formulas at zero hour, 2 hours, and 4 hours for each of the 3 sampling dates were acceptable for human consumption. CONCLUSION: Judicious BTF recipe selection and adherence to safe food handling provide a safe feeding substrate equivalent to CF in the hospital setting. Due to increased use and interest in BTF by patients and their caregivers, healthcare facilities may need to reexamine their policies prohibiting BTF use.

Hoarding among Jewish Holocaust Survivors: Moving Toward a Theoretical Model.

BACKGROUND: Previously described as a subcategory of obsessive compulsive disorder (OCD), hoarding disorder was added to the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as a stand-alone diagnosis for the first time. The first formal research in the 1990s surprisingly found no connection between material deprivation early in life and hoarding; however, later studies linked early traumatic life experiences with hoarding. Subsequent familial studies demonstrated a genetic predisposition for hoarding. Emerging evidence suggests a link between a post-traumatic stress disorder (PTSD) and hoarding in Jewish Holocaust survivors. OBJECTIVES: To evaluate the literature on PTSD among Jewish Holocaust survivors for associations between PTSD and hoarding. METHODS: A systematic search of selected databases, including PubMed, Google Scholar, NCBI, Psych Info, and EBSCO Host was conducted from 1 March 2017 to 15 July 2018 using the following search terms: hoarding, hoarding disorder, obsessive compulsive disorder, OCD, compulsive hoarding, Jewish Holocaust survivors, Shoa, post-traumatic stress disorder, and PTSD. Inclusion criteria included peer reviewed research published on adults in English since 1990. Because no publications linking hoarding and PTSD in Jewish Holocaust survivors were found, references in retained papers were also searched for any relevant published work. RESULTS: Seven articles linking PTSD and hoarding were identified for this review. However, no articles were found linking PTSD and hoarding in Jewish Holocaust survivors. CONCLUSIONS: A relationship between PTSD and hoarding in Jewish Holocaust survivors is conceivable and should be explored to effectively diagnose and care for affected individuals.

Blended tube feeding prevalence, efficacy, and safety: What does the literature say?

BACKGROUND AND PURPOSE: For most of human history, physicians used blended whole foods for patients who are unable to eat by mouth. However, by the 1960s and 1970s, advances in enteral nutrition resulted in the gradual displacement of blenderized tube feedings (BTFs) with commercial formulas. There are advantages and disadvantages to commercial formulas and BTFs. The purpose of this article was to review the literature for the incidence of blended tube feeding use and its safety, efficacy, and implications for clinical practice. METHODS: A search of the scientific literature in PubMed, CINAHL, Cochrane, ProQuest, and Ovid was conducted using the keywords "blenderized tube feeding" and "blended tube feeding." Articles were divided into two categories: 1) frequency of use and experiences of BTF in patients or caregivers and health care providers and 2) safety/efficacy studies. CONCLUSIONS: The literature review shows a rising interest in BTF, with more research on efficacy indicated. IMPLICATIONS FOR PRACTICE: The use of BTF is primarily patient or caregiver driven. Blenderized tube feeding requires oversight by health care providers just as commercial formulas. Health care providers should be aware of the use of BTF and the effect it can have on different patient populations regarding content, cost, safety, and efficacy in the clinical and home settings.

Reemergence of Blended Tube Feeding and Parent's Reported Experiences in Their Tube Fed Children.

OBJECTIVE: Healthcare providers (HCPs) report increased interest in blenderized tube feeding (BTF) as an alternative to commercial formula (CF) feeding-particularly in families of tube fed children. The objective of this study was to explore parents' reported experiences of CF and BTF in their children. DESIGN: Prospective descriptive study utilizing a convenience sample. SETTING/SUBJECTS: Parents (n = 433) of tube fed children in an online tube feeding support group completed an electronic survey to compare experiences of CF and BTF in their tube fed children. RESULTS: The sample was evenly represented by parents using CF (50.5%) and BTF (49.5%). Reasons parents chose BTF included desire to provide whole foods (20.2%), decrease symptoms of tube feeding intolerance (19.7%), provide family meals (12.2%), increase oral intake (10.8%), address allergies (5.3%), or because they did not like formula (19.7%). Parents reported fewer symptoms of tube feeding intolerance on BTF and their children more frequently met growth goals compared to formula feeding. Only half (49.3%) of parents using BTF referred to HCPs for recipes and feeding oversight. The primary reasons parents did not use BTF included lack of knowledge (50.9%) or time constraints (20.0%). CONCLUSIONS: A significant number of parents in this sample successfully provide full or partial BTF to their children but only half rely on HCPs for guidance. There is wide variability in BTF preparation and delivery. Parents who use or have interest in BTF need knowledgeable and supportive HCPs for guidance and follow-up due to the unique nutritional needs of this patient population. HCPs need to be prepared to screen families of tube fed children who are using BTF or are interested in this feeding alternative to CF. Healthcare facilities need to evaluate their enteral feeding policies to accommodate patients on BTF.

A New System of Documentation to Improve Dietitian-Physician Crosstalk.

BACKGROUND: Standardization of the dietetic care process allows for early identification of malnutrition and metabolic disorders, interdisciplinary collaboration among the medical team, and improved quality of patient care. Globally, dietitians are adopting a nutrition care model that integrates national regulations with professional scope of practice. Currently, Israel lacks a standardized dietetic care process and documentation terminology. OBJECTIVES: To assess the utilization of a novel sectoral documentation system for nutrition care in Israel. METHODS: Seventy dietitians working in 63 geriatric facilities completed an online training program presenting the proposed patient-sectoral-model. Training was followed by submission of sample case studies from clinical practice or completion of a case simulation. Application of the proposed model was assessed by measuring the frequency participants implemented different sections of the model and responses to an approval questionnaire. RESULTS: Fifty-four participants (77%) provided completed cases. Over 80% of participants reported each step of the proposed dietary care process with 100% reporting the "nutrition diagnosis". Fifty-one dietitians (72.8%) completed the approval survey with the section on nutrition diagnosis receiving a highly favorable response (95%), indicating that the new documentation system was beneficial. Over 80% of participants rated the model useful in clinical practice. CONCLUSIONS: A sectoral approach for documenting dietetic care may be the ideal model for dietitians working in specific patient populations with the potential for improving interdisciplinary collaboration in patient care.

Survey study assessing attitudes and experiences of pediatric registered dietitians regarding blended food by gastrostomy tube feeding.

BACKGROUND: Families of children requiring nutrition support may be interested in providing blenderized food by gastrostomy tube (BFGT). Some registered dietitians (RDs) recommend partial or full BFGT for children with tube feeding intolerance who are unresponsive to standard interventions. There is little published information on the safety and efficacy of BFGT feeding. The purpose of this survey was to elicit experiences of pediatric RDs with BFGT in clinical practices. METHODS: A survey instrument was distributed to members of the Pediatric Nutrition Practice Group to report experiences of BFGT in clinical practice. RESULTS: Response rate was 9.9% of total members (N = 2,448). Over half (58%) of the 244 respondents use and recommend BFGT. Reasons for use included parent request (70.2%), tube feeding intolerance (22.9%), and inability to obtain commercial formula (6.1%). Seventy-nine percent reported an overall positive outcome with BFGT. Older RDs were more familiar with BFGT but less likely to use it compared with younger RDs who use BFGT or wanted more information (P = .007). Twelve percent did not use or recommend BFGT due to concerns about bacterial contamination, unknown nutrient composition, inability to provide follow-up, and/or facility policy violations. Twenty-eight percent were familiar with BFGT but wanted more information. CONCLUSIONS: Interest in BFGT is largely parent-driven or explored as an option for children with tube feeding intolerance. Almost 80% of RDs using this feeding substrate report overall positive outcomes, but 28% indicate they want more information on using BFGT in clinical practice.