Objective: To evaluate the effect of early intrajejunalnutrition in attenuating bacterial and/or endotoxintranslocation and improving gut barrier function ofsevere acute pancreatitis (SAP) in dogs.Methods: 15 dogs wer...Objective: To evaluate the effect of early intrajejunalnutrition in attenuating bacterial and/or endotoxintranslocation and improving gut barrier function ofsevere acute pancreatitis (SAP) in dogs.Methods: 15 dogs were divided into parenteral nutrition(PN) group(7 dogs)and early intrajejunal nutrition(EIN) group(8). EIN was delivered nutrients via a nee-dle jejunostomy catheter feeding at 48h after operation.SAP model was induced by injecting 1 ml/kg of com-bined solution of 5% sodium taurocholate and 8000-10000 BAEE units trypsin/ml into the pancreas via thepancreatic duct. Systemic blood samples were ob-tained before and 1, 3, 5, 7 d following SAP, and culturedby aerobic as well as anaerobic bacterial growth. Systemicplasma and portal vein endotoxin levels were quantifiedby the chromogenic limulus amebocyte lysate (LAL)technique. Portal vein blood and specimens of tissuefrom the mesenteriolum and mesocolon lymph nodes,lung, pulmonary portal lymph nodes, pancreatitis tissueand periopancreas tissue were adopted before the experi-ment was finished. Aliquots of the homogenata were cul-tured as blood mentioned above to determine the magnitudeof the bacteria DNA, protein and the villi, the thickness ofmucosa, and the whole bowel wall of the ileum and trans-verse colon were measured.Results: The study showed that the levels of systemicplasma endotoxin and the magnitude of bacterialtranslocation to the portal and systemic blood and dis-tant organ were reduced significantly in the EINgroup as compared with the TPN group. The contentsof protein and DNA, the height of villi, the thicknessof mucosa and whole bowel wall of the ileum andtransverse colon in the EIN group were higher thanthose in the PN group.Conclusion: Our results suggested that EIN is safe andeffective to be adopted by intrajejunal delivery of nu-trients in SAP, decreases the occurrence of gut bacterialtranslocation, and improves the gut barrier function.展开更多
Background:Most of the evidence on early feeding of preterm infants was derived from high income settings,it is equally important to evaluate whether it can be successfully implemented into less resourced settings.Thi...Background:Most of the evidence on early feeding of preterm infants was derived from high income settings,it is equally important to evaluate whether it can be successfully implemented into less resourced settings.This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital,a tertiary referral hospital in a middle income country.Methods:The new aggressive feeding policy was developed mainly from Cochrane review evidence,using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk.A total of 80 preterm babies(34 weeks and below)discharged from NICU were included(40 pre-and 40 post-intervention).Pre and post-intervention data were compared.The primary outcome was growth at day 7,14,21 and at discharge and secondary outcomes were time to full oral feeding,breastfeeding rates,and adverse events.Results:Complete data were available for all babies to discharge.One baby was discharged prior to day 14 and 10 babies before day 21,so growth data for these babies were unavailable.Baseline data were similar in the two groups.There was no significant weight difference at 7,14,21 days and at discharge.More post-intervention babies were breastfed at discharge than pre-intervention babies(21 vs.8,P=0.005).Nosocomial infection(11 vs.4,P=0.045),and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies(31 vs.13,P=0.01).The post-intervention babies were more likely to achieve shorter median days(interquartile range)to full oral feeding[11(6)days vs.13(11)days,P=0.058]and with lower number affecting necrotising enterocolitis(0 vs.5,P=0.055).Conclusion:Early aggressive parenteral nutrition and early provision of mother’s milk did not result in improved growth as evidenced by weight gain at discharge.However we found more breastfeeding babies,lower nosocomial infection and transfusion rates.Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes.展开更多
文摘Objective: To evaluate the effect of early intrajejunalnutrition in attenuating bacterial and/or endotoxintranslocation and improving gut barrier function ofsevere acute pancreatitis (SAP) in dogs.Methods: 15 dogs were divided into parenteral nutrition(PN) group(7 dogs)and early intrajejunal nutrition(EIN) group(8). EIN was delivered nutrients via a nee-dle jejunostomy catheter feeding at 48h after operation.SAP model was induced by injecting 1 ml/kg of com-bined solution of 5% sodium taurocholate and 8000-10000 BAEE units trypsin/ml into the pancreas via thepancreatic duct. Systemic blood samples were ob-tained before and 1, 3, 5, 7 d following SAP, and culturedby aerobic as well as anaerobic bacterial growth. Systemicplasma and portal vein endotoxin levels were quantifiedby the chromogenic limulus amebocyte lysate (LAL)technique. Portal vein blood and specimens of tissuefrom the mesenteriolum and mesocolon lymph nodes,lung, pulmonary portal lymph nodes, pancreatitis tissueand periopancreas tissue were adopted before the experi-ment was finished. Aliquots of the homogenata were cul-tured as blood mentioned above to determine the magnitudeof the bacteria DNA, protein and the villi, the thickness ofmucosa, and the whole bowel wall of the ileum and trans-verse colon were measured.Results: The study showed that the levels of systemicplasma endotoxin and the magnitude of bacterialtranslocation to the portal and systemic blood and dis-tant organ were reduced significantly in the EINgroup as compared with the TPN group. The contentsof protein and DNA, the height of villi, the thicknessof mucosa and whole bowel wall of the ileum andtransverse colon in the EIN group were higher thanthose in the PN group.Conclusion: Our results suggested that EIN is safe andeffective to be adopted by intrajejunal delivery of nu-trients in SAP, decreases the occurrence of gut bacterialtranslocation, and improves the gut barrier function.
文摘Background:Most of the evidence on early feeding of preterm infants was derived from high income settings,it is equally important to evaluate whether it can be successfully implemented into less resourced settings.This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital,a tertiary referral hospital in a middle income country.Methods:The new aggressive feeding policy was developed mainly from Cochrane review evidence,using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk.A total of 80 preterm babies(34 weeks and below)discharged from NICU were included(40 pre-and 40 post-intervention).Pre and post-intervention data were compared.The primary outcome was growth at day 7,14,21 and at discharge and secondary outcomes were time to full oral feeding,breastfeeding rates,and adverse events.Results:Complete data were available for all babies to discharge.One baby was discharged prior to day 14 and 10 babies before day 21,so growth data for these babies were unavailable.Baseline data were similar in the two groups.There was no significant weight difference at 7,14,21 days and at discharge.More post-intervention babies were breastfed at discharge than pre-intervention babies(21 vs.8,P=0.005).Nosocomial infection(11 vs.4,P=0.045),and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies(31 vs.13,P=0.01).The post-intervention babies were more likely to achieve shorter median days(interquartile range)to full oral feeding[11(6)days vs.13(11)days,P=0.058]and with lower number affecting necrotising enterocolitis(0 vs.5,P=0.055).Conclusion:Early aggressive parenteral nutrition and early provision of mother’s milk did not result in improved growth as evidenced by weight gain at discharge.However we found more breastfeeding babies,lower nosocomial infection and transfusion rates.Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes.
