Early selective enteral feeding in treatment of acute pancreatitis: A case report

BACKGROUND Early initiation of enteral feeding is recognized to play a crucial role in improving the outcomes of treatment of acute pancreatitis.However,the method of adminis-tration of enteral nutrition remains debatable.We present the experience of treating a patient with moderate-severe acute pancreatitis,at high risk of progressing to a severe or fatal condition,using a novel method of selective feeding with duodenal isolation.CASE SUMMARY A 27-year-old female patient presented to the emergency unit of the hospital with a typical manifestation of acute pancreatitis.Despite a conventional treatment,the patient’s condition deteriorated by day 2 of hospitalization.Using an endoscopic approach,a novel catheter PandiCathffwas placed to the duodenum of the patient,isolating its segment between the duodenal bulb and the ligament of Treitz.In the isolated area created,a negative pressure was applied,followed by introduction of early selective enteral feeding.The patient’s condition subsequently improved in a rapid manner,and no complications often associated with moderate-to-severe acute pancreatitis developed.CONCLUSION Within 48 h of starting treatment with the novel method,it can prevent the development of multiple organ failure and,when combined with minimally invasive drainage methods,help prevent infection.

Early warning systems for enteral feeding intolerance in patients with stroke

Objective:The objective of this study was to construct an early warning system(EWS)to facilitate risk assessment,early identification,and appropriate treatment of enteral nutrition feeding intolerance(FI)in patients with stroke,so as to provide a reference for risk classification standards and interventions toward a complete EWSs for nursing care of stroke.Materials and Methods:Based on evidence and clinical nursing practice,a structured expert consultation method was adopted on nine experts over two rounds of consultation.Statistical analysis was used to determine the early warning index for FI in patients with stroke.Results:The expert authority coefficient was 0.89;the coefficients of variation for the two rounds of consultation were 0.088-0.312 and 0.096-0.214,respectively.There were significant differences in the Kendall’s concordance coefficient(P<0.05).Finally,22 items in five dimensions of patient age,disease,treatment,biochemical,and enteral nutrition-related factors were identified.Conclusion:The early warning index for FI in patients with a history of stroke is valid and practical.It provides a reference for the early clinical identification of FI risk.

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis.However,few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis.Moreover,no consensus on goal enteral caloric intake has been reached in sepsis.AIM To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis.METHODS Patients were randomly assigned to receive 30%(defined as group A),60%(group B),or 100%(group C)of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial.The acute gastrointestinal injury(AGI)grades,incidence of feeding intolerance(FI),daily caloric intake,nutritional and inflammatory markers,and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding.The clinical severity and outcome variables were also recorded.RESULTS A total of 54 septic patients were enrolled.The days to goal calorie of group C(2.55±0.82)were significantly longer than those of group A(3.50±1.51;P=0.046)or B(4.85±1.68;P<0.001).The FI incidence of group C(16.5%)was higher than that of group A(5.0%)or B(8.7%)(P=0.009).No difference in the incidence of FI symptoms was found between groups A and B.The serum levels of barrier function biomarkers of group B were significantly lower than those of group A(P<0.05)on the 7th day of feeding.The prealbumin and IL-6 levels of group A were lower than those of group B(P<0.05)on the 7th day of feeding.No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups.CONCLUSION Early moderate enteral underfeeding(60%of goal requirements)could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis.However,further large-scale prospective clinical trials and animal studies are required to test our findings.Moreover,the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.

Multi-center Study of Enteral Feeding Practices in Hospitalized Late Preterm Infants in China

Objective To investigate the current enteral feeding practices in hospitalized late preterm infants in the Beijing area of China. Methods A multi-center, cross-sectional study was conducted. Infants born after 34 weeks and before 37 weeks of gestation were enrolled from 25 hospitals in the Beijing area of China from October 2015 to October 2017. Data on enteral feeding practices were collected and analyzed. Results A total of 1,463 late preterm infants were enrolled, with a mean gestational age（GA） of 35.6（34.9, 36.1） weeks. The percentage of exclusive breastfeeding was 4.5% at the initiation of enteral feeding but increased to 14.4% at discharge. When human milk was not available, most infants（46.1%） were fed with preterm infant formula. The rate of exclusive human milk feeding in infants born at 34 weeks gestation was higher than at discharge（21.1% of infants born at 34 weeks＇ GA versus 12.1% of infants born at 35 weeks＇ GA versus 12.3% of infants born at 36 weeks＇ GA, P 〈 0.001）. Only 28.4% of late preterm infants achieved full enteral feeding at discharge, and only 19.2% achieved 120 kcal/（kg·d） by enteral feeding at discharge. Importantly, 40.5% of infants did not regain the birth weight at discharge. Conclusion Enteral feeding support of late preterm infants has not been standardized to achieve optimal growth. Moreover, the human milk feeding rate was low, and many late preterm infants did not achieve the goal of enteral feeding and failed to regain birth weight at the time of discharge. More aggressive enteral feedings protocols are needed to promote human milk feeding and optimize growth for late preterm infants.

Development of a prediction model for enteral feeding intolerance in intensive care unit patients:A prospective cohort study

BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.METHODS A prospective cohort study was performed.The enrolled patients’basic information,medical status,nutritional support,and gastrointestinal(GI)symptoms were recorded.The baseline data and influencing factors were compared.Logistic regression analysis was used to establish the model,and the bootstrap resampling method was used to conduct internal validation.RESULTS The sample cohort included 203 patients,and 37.93%of the patients were diagnosed with EFI.After the final regression analysis,age,GI disease,early feeding,mechanical ventilation before EN started,and abnormal serum sodium were identified.In the internal validation,500 bootstrap resample samples were performed,and the area under the curve was 0.70(95%CI:0.63-0.77).CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.

Nasogastric or nasointestinal feeding in severe acute pancreatitis

AIM:To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and nasointestinal(NI)(beyond the ligament of Treitz) feeding in severe acute pancreatitis(SAP).METHODS:After bedside intragastric insertion,tube position was assessed,and enteral nutrition(EN) started at day 4,irrespective of tube localization.Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric(NG) or NI tube.RESULTS:Spontaneous tube migration to a NI site occurred in 10/25(40%) prospectively enrolled SAP patients,while in 15(60%) nutrition was started with a NG tube.Groups were similar for demographics and pancreatitis aetiology but computed tomography(CT) severity index was higher in NG tube patients than in NI(mean 6.2 vs 4.7,P=0.04).The CT index seemed a risk factor for failed obtainment of spontaneous distal migration.EN trough NG or NI tube were similar in terms of tolerability,safety,clinical goals,complications and hospital stay.CONCLUSION:Spontaneous distal tube migration is successful in 40% of SAP patients,with higher CT severity index predicting intragastric retention;in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.

Are Fetuses Affected by Gastroschisis Benefited from Prenatal Maternal Corticosteroid Use and Early Parturition?

Introduction: Gastroschisis (G) is a congenital defect of the abdominal walls through which intestinal herniation and permanent exposure to amniotic liquid (AL) and its components are developed at the end of gestation. G affects mostly fetuses from young mothers under 25 - 29 years old, but it occurs more often in fetuses of mothers’ ages between 12 - 15 years old. Some authors assert that it is not the low weight, nor the low gestational age that influences mortality. In addition to morphological alterations, histological alterations are characterized by disorganization, distribution and the degree of ganglia maturity and myenteric plexuses. The literature describes parturition anticipation of G disease carriers to minimize damages to intestinal loops. There are studies suggesting corticosteroids at the end of gestation in order to avoid morphological and histological damages to the intestinal loop. Objective: Identify if live newborn infants delivery anticipation, that is, gestational date less than 37 weeks and prenatal maternal use of corticosteroid were benefited from early enteral diet, namely, less than 10 post-surgery days. Material and Method: From 33 newborns researched in the period from 2010 to 2014;28 newborns full records were included in the study with 15.2% mortality rate. These newborns were divided in 3 groups according to maternal age: 6 newborns from mothers’ age between 16 - 20 years old (Group 1);14 newborns from mothers’ age between 21 - 25 years old (Group 2) and 8 newborns from mothers’ age between 26 - 29 years old (Group 3). Gestational age at birth and prenatal maternal usage of corticosteroid and beginning oral feeding were assessed. Results: From 28 newborns, 19 mothers ingested prenatal corticosteroid and 16 newborns received the first enteric diet 10 days before and 3 days later. The mothers of the other 9 newborns were not treated with corticosteroid;only 3 newborns were fed before 10 days and 6 were fed later (p = 0.0016). Regarding gestational age, 17 newborns were born before 37 weeks and their 1st enteral diet was offered before 10 days. From the 11 newborns born after 37 weeks, only 4 received the 1st enteral diet before 10 days (p = 0.015). Conclusion: Newborn infants born with gestational age below 37 weeks, whose mothers received prenatal corticosteroid, were benefited with the first enteral diet before 10 postoperative days.

Comparison of sequential feeding and continuous feeding on the blood glucose of critically ill patients:a non-inferiority randomized controlled trial

Background:Glucose control is an important aspect in managing critically ill patients.The goal of this study was to compare the effects of sequential feeding(SF)and continuous feeding(CF)on the blood glucose of critically ill patients.Methods:A non-inferiority randomized controlled trial was adopted in this study.A total of 62 patients who were fed enteral nutritional suspension through gastric tubes were enrolled.After achieving 80%of the nutrition target calories(25 kcal·kg^(-1)·day^(-1))through CF,the patients were then randomly assigned into SF and CF groups.In the SF group,the feeding/fasting time was reasonably determined according to the circadian rhythm of the human body as laid out in traditional Chinese medicine theory.The total daily dosage of the enteral nutritional suspension was equally distributed among three time periods of 7 to 9 o’clock,11 to 13 o’clock,and 17 to 19 o’clock.The enteral nutritional suspension in each time period was pumped at a uniform rate within 2 h by an enteral feeding pump.In the CF group,patients received CF at a constant velocity by an enteral feeding pump throughout the study.Blood glucose values at five points(6:00/11:00/15:00/21:00/1:00)were monitored and recorded for seven consecutive days after randomization.Enteral feeding intolerance was also recorded.Non-inferiority testing was adopted in this study,the chi-square test or Fisher test was used for qualitative data,and the Mann-Whitney U test was used for quantitative data to determine differences between groups.In particular,a repeated measure one-way analysis of variance was used to identify whether changes in glucose value variables across the time points were different between the two groups.Results:There were no significant demographic or physiological differences between the SF and CF groups(P>0.050).The average glucose level in SF was not higher than that in CF(8.8[7.3–10.3]vs.10.7[9.1–12.1]mmol/L,Z=-2.079,P for non-inferiority=0.019).Hyperglycemia incidence of each patient was more common in the CF group than that in the SF group(38.4[19.1–63.7]%vs.11.8[3.0–36.7]%,Z=-2.213,P=0.027).Hypoglycemia was not found in either group.Moreover,there was no significant difference during the 7 days in the incidence of feeding intolerance(P>0.050).Conclusions:In this non-inferiority study,the average blood glucose in SF was not inferior to that in CF.The feeding intolerance in SF was similar to that in CF.SF may be as safe as CF for critically ill patients.