Early Feeding vs 5-Day Fasting after Distal Elective Bowel Anastomoses in Children.A Randomized Controlled Trial

Purpose: Determine the safety and efficacy of early enteral feeding after distal elective bowel anastomoses (DEBA) in children. Methods: Controlled randomized trial including pediatric patients with DEBA, excluding non-elective and high risk patients. Variables: Demographics, operative time, anastomosis placement, beginning peristalsis and bowel movement, time to full diet intake, post-operative stay, persisting vomiting and abdominal distention, wound infection or dehiscence, anastomotic leak, reoperation, death. Randomization into: 1) Experimental group (EG): early feeding group, after a minimum 24 hours fasting period, oral fluids and diet was started;2) Control group (CG): obligatory 5-day fasting. Descriptive Statistics: Student’s t test for quantitative and Chi square for qualitative variables, a p-value 0.05 was considered significant. Results: 60 patients were included since June 2003 to May 2004, 30 ineach group. Mean age 2 years, weight16 kg, malnutrition 33%. Stomal Ethiology: Anorectal-malformation 46%, Hirschsprung 13%, inflammatory 35%, tumoral 5%. Mostly in colon 71%. Mean surgical time 142 min. None developed vomiting or required nasogastric-tube. Mild abdominal distension 13%, mild fever 16.5% and wound complications 18%. Anastomosis leakage 6.5%, none required reoperations. Demographic variables showed no statistical differences. Full oral intake was in the 2nd postoperative day in the EG vs CG (p = 0.001). Postoperative hospital stay was 6.0 ± 3 in the EG vs 9.8 ± 4 days in the CG with clinical but not statistical significance. Peristalsis beginning, first flatus passage and bowel movements showed no statistical differences. The complication incidence was low and equally distributed. Conclusions: Early feeding after DEBA is safe and well tolerated in children.

An early feeding regime and a high-density amino acid diet on growth performance of broilers under subclinical necrotic enteritis challenge

Broilers that have early access to feed have been shown to have enhanced immune system and gut development and heightened resilience against necrotic enteritis(NE). This study examined the effect of early feeding a high amino acid density diet on performance of broilers under a sub-clinical NE challenge model. Ross 308 broilers(n = 576) were assigned to a 2 × 2 × 2 factorial design with 2 feeding regimes(feed access either within 6 h post-hatch or after 48 h post-hatch), 2 diets(control diet or the control diet with an additional 10% digestible amino acids [HAA]) and either presence or absence of NE challenge.Oral administrations of Eimeria species(d 9) and a field strain of Clostridium perfringens(d 14) were used to induce NE, Broiler performance was analysed at d 13.23.30 and 35, Intestinal lesion score and bacterial count were analysed on d 16. The NE challenge reduced overall bird performance and induced severe intestinal lesions, without causing notable mortality. At d 23 bird weight was significantly lower(P < 0.001) in the challenged birds compared with the unchallenged birds, but by d 30 the challenged birds had recovered and challenge no longer had an impact on bird performance. Birds fed the HAA diet had greater body weight by d 35 and heightened Lactobacillus content in the ileum at d 16(P < 0.05).Birds that were fed the HAA diet after a period of fasting performed better in terms of feed conversion ratio(FCR) under challenge. The findings from this study suggest there are beneficial effects of feeding high amino acid diets to birds in response to external stresses, such as post-hatch fasting and subclinical NE.

Portal venous gas resulting from umbilical vein catheterization in a very-low-birth-weight infant with no interruption in early feeding

Introduction Portal venous gas(PVG)is common in necrotizing enterocolitis and occasionally occurs in neonates after umbilical vein catheterization(UVC).Therefore,determining the cause of PVG requires further clinical evaluation in these cases.Case presentation We report the case of a very-low-birth-weight infant who underwent UVC after birth.PVG was an unexpected finding on ultrasound following catheterization.The UVC was immediately removed and replaced with a peripherally inserted central catheter.The infant’s physical examination was unremarkable.Bedside X-ray revealed neither PVG nor pneumatosis intestinalis,which would indicate the onset of necrotizing enterocolitis.After full evaluation,breastfeeding was started on the same day.The infant did not develop feeding intolerance,necrotizing enterocolitis,or other disorders.Conclusion PVG occasionally occurs in neonates who undergo UVC and is considered to be caused by exogenous gases.PVG is more easily detected with ultrasound than with X-ray and does not affect early feeding in premature infants.

Effects of early oral feeding after radical total gastrectomy in gastric cancer patients

BACKGROUND Gastric cancer(GC)is a heavy burden in China.Nutritional support for GC patients is closely related to postoperative rehabilitation.However,the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.AIM To prospectively explore the safety,feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.METHODS This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China.A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled.Of which,105 patients were given early oral feeding(EOF group)after surgery,and the other 101 patients were given the traditional feeding strategy(control group)after surgery.Perioperative clinical data were recorded and analyzed.The primary endpoints were gastrointestinal function recovery time and postoperative complications,and the secondary endpoints were postoperative nutritional status,length of hospital stay and expenses,etc.RESULTS Compared with the control group,patients in the EOF group had a significantly shorter postoperative first exhaust time(2.48±1.17 d vs 3.37±1.42 d,P=0.001)and first defecation time(3.83±2.41 d vs 5.32±2.70 d,P=0.004).In addition,the EOF group had a significant shorter postoperative hospitalization duration(5.85±1.53 d vs 7.71±1.56 d,P<0.001)and lower postoperative hospitalization expenses(16.60±5.10 K¥vs 21.00±7.50 K¥,P=0.014).On the 5th day after surgery,serum prealbumin level(214.52±22.47 mg/L vs 204.17±20.62 mg/L,P=0.018),serum gastrin level(246.30±57.10 ng/L vs 223.60±55.70 ng/L,P=0.001)and serum motilin level(424.60±68.30 ng/L vs 409.30±61.70 ng/L,P=0.002)were higher in the EOF group.However,there was no significant difference in the incidence of total postoperative complications between the two groups(P=0.507).CONCLUSION Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function,improve postoperative nutritional status,reduce length of hospital stay and expenses while not increasing the incidence of related complications,which indicates its safety,feasibility and potential benefits for gastric cancer patients.

Efficacy and safety of early oral feeding in postoperative patients with upper gastrointestinal tumor:A systematic review and metaanalysis

BACKGROUND Early oral feeding(EOF)is an important measure for early recovery of patients with gastrointestinal tumors after surgery,which has emerged as a safe and effective postoperative strategy for improving clinical outcomes.AIM To determine the safety and efficacy of early oral feeding in postoperative patients with upper gastrointestinal tumor.METHODS This meta-analysis was analyzed using Review Manager version 5.3 and Stata version 14.All clinical studies that analyzed efficacy and safety of EOF for postoperative patients with upper gastrointestinal tumor were included.RESULTS Fifteen studies comprising 2100 adult patients met all the inclusion criteria.A significantly lower risk of pneumonia was presented in the EOF compared with TOF group[relative risk(RR)=0.63,95%confidence interval(CI):0.44-0.89,P=0.01].Length of hospital stay was significantly shorter in the EOF group than in the TOF group[weighted mean difference(WMD)=-1.91,95%CI:-2.42 to-1.40;P<0.01].Cost of hospitalization was significantly lower(WMD=-4.16,95%CI:-5.72 to-2.61;P<0.01),and CD4 cell count and CD4/CD8 cell ratio on postoperative day 7 were significantly higher in the EOF group than in the TOF group:CD4 count(WMD=7.17,95%CI:6.48-7.85;P<0.01),CD4/CD8 ratio(WMD=0.29,95%CI:0.23-0.35;P<0.01).There was no significant difference in risk of anastomotic leak and total postoperative complications.CONCLUSION EOF as compared with TOF was associated with lower risk of pneumonia,shorter hospital length of stay,lower cost of hospitalization,and significantly improved postoperative immune function of patients.

Influence of Early Quantitative Feed Restriction on Performance and Carcass Characteristics of Broiler Chickens

An experiment was conducted to study the influence of eady quantitative feed restriction on the performance and carcass characteristics of broiler chickens. Two hundred 8-day-old commercial Avian male broiler chicks were assigned to four groups randomly, with 50 broilers each. At the age of 8 days the broilers were restricted to 90%, 80% or 70% of the ad libitum intake for 7 days. When the restricion was finished, all birds received feed ad libitum again. The results showed that diet restriction resulted in a reduction in body weight and daily gain during the restriction period （P 〈0.05）. The birds restricted to 90% of the ad libitum intake showed the occurring of growth compensation in the 3rd week. The birds restricted to 80% and 70% of the ad libitum intake had growth compensation in the 4th week. No significant differences between the effects of the restriction and the control on final body weight, growth rate, feed conversion efficiency and carcass characteristics （P 〈0.05）.

Advances in acute and chronic pancreatitis

Acute pancreatitis(AP)and chronic pancreatitis are the third leading gastrointestinal causes for admissions and readmissions to hospitals in the United States.This review of articles published between 2019-2022(December)from international sources identified four categories of crucial new findings:The report includes(1)New genetic pathogenic mutations(TRPV6);expected genetic outcomes in a Northern European population;(2)a new serum diagnostic marker for AP-fatty acid ethyl esters-distinguishing acute pancreatitis associated with alcohol;explanations of the impact of monocytes/macrophages on the inflammatory process that defines their future in diagnosis,staging,and treatment;(3)innovations in timing of per os low-fat,solid food intake immediately on admission;resolution of concepts of aggressive parenteral fluid intake;dramatic shifts to nonoperative from operative treatment of infected pancreatic necrosis.Each modification reduced interventions,complications,and lengths-of-stay;and(4)authoritarian recommendations for medical treatment of chronic pain.These advances offer opportunities to initiate newly proven treatments to enhance outcomes,alter the natural history,and envision the future of two diseases that have no known cure.

How neonatal diet affects the long-term development of rumination behavior,rumen fermentation and feed digestion in dairy calves fed a high milk level?

This study was to investigate growth performance,rumination development,rumen fermentation and feed digestion in young calves provided high volumes(about 20%of calf birth weight)of milk with or without forage inclusion and how these parameters correlate with each other.Immediately after birth,160 newborn Holstein female calves(41.6±4.2 kg of initial BW)were randomly divided into 2 treatments:1)starter(CON,only starter)and 2)starter and hay(HAY,both starter and hay).The calves were fed their respective experimental diets from d 4 to 84,after which they were all introduced to similar diets until the end of the experiment on d 196.Treatment had no effect on growth and structural measurements throughout the experimental period.However,treatment had an effect on the other parameters,mainly during the post-weaning period.Forage supplementation tended to reduce starter dry matter intake(P=0.05),while increasing the forage intake(P<0.01)and the feed-to-gain ratio(P<0.01).HAY calves had increased neutral detergent fiber(NDF)and physically effective NDF(peNDF)intakes(P<0.05)and tended to lower(P<0.01)starch intake compared to CON calves.The HAY calves had a higher rumination time(P<0.01),ruminal pH(P<0.01),and acetate-to-propionate ratio(P=0.05)compared to the CON calves.Spearman correlation analysis showed that rumination time was positively related to the ruminal p H at d 84(P=0.01)and 196(P=0.02).The HAY calves had similar apparent total-tract digestibility of dry matter(DM),NDF and ether extract(EE),but lower digestibility of organic matter(OM,P=0.03),crude protein(CP,P<0.01)and starch(P<0.01)compared to those of the CON calves at week 12.Furthermore,there were no positive relationships between rumination time and nutrient digestibility or between rumination time per kilogram DM and nutrient digestibility.In conclusion,feeding hay to calves fed a high milk level improved rumination during the post-weaning period only,without a concomitant effect on growth performance throughout the experimental period,suggesting no detrimental effect of feeding forage in calves fed high milk level.