Safety of decanted enteral formula hung for 12 hours in a pediatric setting.

BACKGROUND: Enteral nutrition has been an accepted mode of pediatric care for more than 40 years. Early reports in the literature documented high levels of bacterial contamination in enteral formulas delivered to patients. Safety standards for formula administration have not been universally followed. Evidence demonstrates that increased manipulation of the delivery system contributes to bacterial contamination. METHODS: A prospective, descriptive study was conducted with 30 pediatric patients. They received continuous enteral feedings using decanted formula over a minimum hang time of 12 hours. Formula was delivered according to current practice recommendations. Cultures were obtained and sent to the laboratory initially and every 4 hours. RESULTS: Cultures from 30 patients (average age 6.4 years) were obtained at baseline, 4, 8, and 12 hours. Nasogastric, nasojejunal, gastrostomy, or gastrojejunostomy feeding tubes were used. Formulas administered were polymeric and peptide based. Of the 119 cultures obtained, 8 were either collected improperly or revealed a contaminant. Of the 111 useable cultures, 100 showed no growth, 6 had growth below the Food and Drug Administration threshold for contamination (95% acceptable), and 5 (5%) in 2 patients were considered positive, with all cultures growing coliforms. No patient had any clinical signs of bacterial gastroenteritis (increased stool output, fever, or clinical deterioration) over the 48 hours after data collection. CONCLUSION: Decanted enteral formula administered continuously over 12 hours in a pediatric hospital setting has a lower than expected rate of bacterial growth when recommended handling practices are followed.

Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study.

OBJECTIVE: To define epidemiologic and clinical characteristics of newly diagnosed pediatric inflammatory bowel disease (IBD) in a large population-based model. STUDY DESIGN: All pediatric gastroenterologists providing care for Wisconsin children voluntarily identified all new cases of IBD during a 2-year period. Demographic and clinical data were sent to a central registry prospectively for analysis. RESULTS: The incidence of IBD in Wisconsin children was 7.05 per 100,000, whereas the incidence for Crohn's disease was 4.56, more than twice the rate of ulcerative colitis (2.14). An equal IBD incidence occurred among all ethnic groups, and children from sparsely and densely populated counties were equally affected. The majority (89%) of new IBD diagnoses were nonfamilial. CONCLUSIONS: This study provides novel, prospective, and comprehensive information on pediatric IBD incidence within the United States. The surprisingly high incidence of pediatric IBD, the predominance of Crohn's disease over ulcerative colitis, the low frequency of patients with a family history, the equal distribution of IBD among all racial and ethnic groups, and the lack of a modulatory effect of urbanization on IBD incidence collectively suggest that the clinical spectrum of IBD is still evolving and point to environmental factors contributing to the pathogenesis.