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Romano C, Lionetti P, Spagnuolo MI, Amarri S, Diamanti A, Verduci E, Lezo A, Simona G. Trends and challenges in home enteral feeding methods for children with gastrointestinal disorders: an expert review on bolus feeding delivery methods. Expert Rev Gastroenterol Hepatol 2024; 18:193-202. [PMID: 38030649 DOI: 10.1080/17474124.2023.2289530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION New evidence supports the benefits of bolus feeding for children receiving home enteral feeding (HEN). Current home methods of bolus feeding have certain limitations, particularly in mobile or restless patients. Therefore, innovative delivery methods have been introduced to provide more flexible methods of reducing feeding time and formula handling. AREAS COVERED This manuscript presents an expert review of the updates in HEN for children and the results of an online user experience questionnaire about an innovative new cap-based bolus feeding system. A literature bibliographic search was conducted on Medline via PubMed up to September 2023 to collect relevant studies. We presented recent evidence demonstrating a dramatic increase in HEN use among children requiring EN and its benefits on patients' nutritional status and quality of life. In addition, the article examined the clinical and social benefits of bolus feeding and current challenges in delivery methods. We described the benefits of the new system and its user experience. EXPERT OPINION The uses and indications for bolus feeding in HEN are increasing among children. However, there are still some unmet needs regarding traditional delivery methods. Innovative techniques can improve flexibility, reduce feeding time, and improve user experience and quality of life.
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Affiliation(s)
- Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Department NEUROFARBA - University of Florence, Florence, Italy
| | - Maria Immacolata Spagnuolo
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Sergio Amarri
- Pediatric Palliative Care, Fondazione Hospice MT. C. Seràgnoli, BO, Bentivoglio, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children's Hospital, Rome, Italy
| | - Elvira Verduci
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Antonella Lezo
- Division of Clinical Nutrition, Regina Margherita Children's Hospital, Turin, Italy
| | - Gatti Simona
- Department of Pediatrics,Università Politecnica delle Marche, Italy
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Zambelli L, Aumar M, Ley D, Antoine M, Coopman S, Morcel J, Bequet E, Guimber D, Cailliau E, Peretti N, Gottrand F. Home enteral nutrition does not decrease oral feeding in children during the first year of nutritional support. Clin Nutr 2024; 43:781-786. [PMID: 38340410 DOI: 10.1016/j.clnu.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Enteral nutrition is necessary when nutritional status is poor and oral intake is insufficient or impossible. Although it has been suspected to reduce spontaneous oral feeding, no study has formally assessed the influence of enteral nutrition on pediatric oral intake. The present study aimed to evaluate variation in oral feeding intake after enteral nutrition initiation, and to identify factors influencing oral feeding. METHODS This retrospective cohort study included 149 pediatric patients from two French tertiary care hospitals, who received home enteral nutrition from 2009 to 2022. The patients were aged 2 months to 17 years (median age 3 years, interquartile range 1.3-9.2). Oral and enteral intakes were assessed when enteral nutrition was initiated (M0), and again at M3 (n = 123), M6 (n = 129), and M12 (n = 134) follow-ups, based on dieticians' and home services' reports. Oral feeding and body mass index z score variations during follow-ups were evaluated using a linear mixed regression model, including "time" as a fixed effect and "patient" as a random effect. Factors associated with oral feeding changes were assessed using a model interaction term. RESULTS Oral intake did not vary significantly (P = 0.99) over time and accounted for 47.4% ± 27.4%, 46.9% ± 27.4%, 48.4% ± 28.2%, and 46.6% ± 26.9% of the ideal recommended daily allowance (calculated for the ideal weight for height) at M0, M3, M6, and M12, respectively. Delivery method (nasogastric tube versus gastrostomy), prematurity, underlying disease, history of intrauterine growth retardation, and speech therapy intervention did not influence oral intake. Administration (i.e., exclusively continuous nocturnal infusion versus daytime bolus) led to different oral intake development, although oral intake also differed at M0. CONCLUSIONS Enteral nutrition, although increasing total energy intake, does not alter oral feeding during the first year of administration. Only the mode of administration might influence oral intake.
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Affiliation(s)
- L Zambelli
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France; Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Liège University Hospital, Liège, Belgium.
| | - M Aumar
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - D Ley
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - M Antoine
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - S Coopman
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - J Morcel
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - E Bequet
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Liège University Hospital, Liège, Belgium.
| | - D Guimber
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - E Cailliau
- Biostatistics Department, CHU Lille, F-59000 Lille, France.
| | - N Peretti
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hospices Civils de Lyon, Lyon, France.
| | - F Gottrand
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
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Bahraini A, Purcell LN, Cole K, Koonce R, Richardson L, Trembath A, deJong N, Sutton A, Hayes AA, Phillips MR. Failure to thrive, oral intake, and inpatient status prior to gastrostomy tube placement in the first year of life is associated with persistent use 1-year later. J Pediatr Surg 2022; 57:723-727. [PMID: 35400490 DOI: 10.1016/j.jpedsurg.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gastrostomy tube (GT) placement is a common procedure in infants (≤1-year-old). There is variation in patient selection and a paucity of studies examining which patients require long term enteral access. The objective of this study was to assess demographic and clinical factors associated with persistent GT use (PGU) at 1-year after placement. METHODS We performed a single-institution retrospective review of patients ≤1-year-old who underwent GT placement from January 31, 2014, and January 31, 2020, using institutional NSQIP-P data supplemented with chart review. Multivariable logistic regression analysis was performed to identify factors associated with PGU. Clinical predictors were selected a priori, and a p-value less than 0.05 was used to detect a significant association. RESULTS 140 patients were included, and 118 had a 1-year follow-up. At 1-year following GT placement, 38 patients had weaned from their GT (32.2%). Failure to thrive (FTT), and inpatient admission prior to surgery are associated with increased odds of PGU at 1-year after surgery, OR: 5.19 and 6.02, respectively. There is an inverse association between the percentage of feeds taken by mouth at the time of surgery and the odds of PGU at 1-year (OR: 0.03). CONCLUSION Patients who have FTT (documented prior to surgery) or an inpatient admission prior to GT had a higher odds of PGU at 1-year post-op. Additionally, the amount taken by mouth at the time of GT placement was inversely related to PGU. These factors are important in determining the need for a surgical gastrostomy tube. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Anoosh Bahraini
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Laura N Purcell
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Kristen Cole
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Robin Koonce
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Lisa Richardson
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Andrea Trembath
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Neal deJong
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Ashley Sutton
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Andrea A Hayes
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Michael R Phillips
- Department of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
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Ayala Germán AG, Ignorosa Arellano KR, Díaz García L, Zárate Mondragón F, Toro Monjaraz EM, Cadena León JF, Montijo Barrios E, Ramírez Mayans JA. Nutritional benefits in pediatric patients with percutaneous endoscopic gastrostomy placement. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:680. [PMID: 35485250 DOI: 10.17235/reed.2022.8866/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gastrostomy is an enteral nutrition option. Indications for its placement are diverse, among them, the alteration in the mechanics of swallowing, frequently present in patients with neurological diseases. Nutritional recovery is the objective in these patients evaluating the nutritional status after the placement of a PEG in the pediatric population. This is a retrospective cohort conducted to evaluate nutritional recovery in pediatric patients with PEG placement. It was performed using anthropometric and biochemical parameters before and after placement. Forty-seven subjects were included, from which weight, height, and upper arm circumference were obtained, to evaluate nutritional recovery using BMI or W/L according to age. Significant nutritional improvement was demonstrated in a population of 39 patients, who had a mean follow-up of 7 months. In our population, PEG is an enteral nutrition strategy that has a significant positive impact on nutritional status in a mean of 7 months after its placement. Therefore, considering the evolution time of these patients will guide the clinician in making decisions regarding surveillance and monitoring parameters of the nutritional status.
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Affiliation(s)
| | | | - Luisa Díaz García
- Metodología de la Investigación, Instituto Nacional de Pediatría, México
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García Mancebo J, de la Mata Navazo S, López-Herce Arteta E, Montero Mateo R, López Esteban IM, Mazzuchelli Domínguez A, Sánchez Doutel M, López-Herce Cid J, González Cortés R. A comparative two-cohort study of pediatric patients with long term stay in ICUs. Sci Rep 2021; 11:4631. [PMID: 33633291 PMCID: PMC7907334 DOI: 10.1038/s41598-021-84248-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022] Open
Abstract
During the last decades, the number of patients with long stay admissions (LSA) in PICU has increased. The purpose of this study was to identify factors associated with PICU LSA, assessing healthcare resources use and changes in the profile of these patients. A retrospective, observational, single-center study was carried out. Characteristics of LSA were compared between two periods (2006–2010 and 2011–2015). During the earlier period there were 2,118 admissions (3.9% of them LSA), whereas during the second period, there were 1,763 (5.4% of them LSA) (p = 0.025). LSA accounted for 33.7% PICU stay days during the first period and 46.7% during the second (p < 0.001). Higher use of non-invasive ventilation (80.2% vs. 37.8%, p = 0.001) and high-flow oxygen therapy (68.8% vs. 37.8%, p = 0.005) was observed in the 2011–2015 cohort, whereas the use of arterial catheter (77.1% vs. 92.6%, p = 0.005), continuous infusion of adrenaline (55.2% vs. 75.9%, p = 0.004), and hemoderivative transfusion (74% vs. 89.2%, p = 0.010) was less frequent. In the 2006–2010 cohort, hospital-acquired infections were more common (95.2% vs. 68.8%, p < 0.001) and mortality was higher (26.8% vs. 13.8%, p = 0.026). The number of long-stay PICU admissions have increased entailing an intensive use of healthcare resources. These patients have a high risk for complications and mortality.
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Affiliation(s)
- Julia García Mancebo
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain
| | - Sara de la Mata Navazo
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain
| | - Estíbaliz López-Herce Arteta
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain
| | - Rosario Montero Mateo
- Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - Isabel María López Esteban
- Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - Adriana Mazzuchelli Domínguez
- Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - María Sánchez Doutel
- Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - Jesús López-Herce Cid
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain.,Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain.,Maternal and Child Health and Development Research Network RETICS Funded By Institute of Health Carlos III (ISCIII) Ref: RD16/0022, Madrid, Spain
| | - Rafael González Cortés
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain. .,Maternal and Child Health and Development Research Network RETICS Funded By Institute of Health Carlos III (ISCIII) Ref: RD16/0022, Madrid, Spain.
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Suh CR, Kim W, Eun BL, Shim JO. Percutaneous Endoscopic Gastrostomy and Nutritional Interventions by the Pediatric Nutritional Support Team Improve the Nutritional Status of Neurologically Impaired Children. J Clin Med 2020; 9:jcm9103295. [PMID: 33066538 PMCID: PMC7602143 DOI: 10.3390/jcm9103295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022] Open
Abstract
Aim: To evaluate the long-term effects of nutritional improvement following percutaneous endoscopic gastrostomy (PEG) tube feeding stratified by previous feeding method and to assess the impact of underlying muscle tone on the outcomes of the nutritional intervention. Methods: Neurologically impaired children who underwent PEG tube insertion and nutritional intervention provided by a pediatric nutritional support team were enrolled. We measured anthropometric variables, laboratory parameters, and nutritional intake at baseline, 6 months after PEG insertion, and the last visit. We evaluated the percent ideal body weight (PIBW), body mass index (BMI)-for-age z-score, and percentiles and calculated the ratios of calorie intake compared to required requirement (CIR) and protein intake compared to recommended requirement (PIR). Results: The PIBW and BMI-for-age z-score improved during the first 6 months (p = 0.003 and p = 0.005, respectively). The CIR (p = 0.015) and PIR (p = 0.004) increased during the study period. The baseline BMI and PIBW of the previous nasogastric tube feeding group were better than those of the oral feeding group (p = 0.02 and p = 0.03, respectively). The BMI-for-age z-score, PIBW, CIR, and PIR improved in the hypertonic group (p = 0.03, 0.02, 0.03, and 0.01, respectively). Conclusion: PEG tube feeding and active nutritional intervention improved the nutritional status of neurologically impaired children immediately after PEG insertion. The nutritional requirements might vary by the muscle tonicity.
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Affiliation(s)
- Chae-ri Suh
- Department of Pediatrics, Korea University College of Medicine, Korea University Guro Hospital 1, Seoul 08308, Korea; (C.-r.S.); (B.-L.E.)
- Pediatric Nutritional Support Team, Korea University Guro Hospital, Seoul 08308, Korea;
| | - Wonkyung Kim
- Pediatric Nutritional Support Team, Korea University Guro Hospital, Seoul 08308, Korea;
| | - Baik-Lin Eun
- Department of Pediatrics, Korea University College of Medicine, Korea University Guro Hospital 1, Seoul 08308, Korea; (C.-r.S.); (B.-L.E.)
| | - Jung Ok Shim
- Department of Pediatrics, Korea University College of Medicine, Korea University Guro Hospital 1, Seoul 08308, Korea; (C.-r.S.); (B.-L.E.)
- Pediatric Nutritional Support Team, Korea University Guro Hospital, Seoul 08308, Korea;
- Correspondence: ; Tel.: +82-2-2626-3157
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Cortez AR, Warren PW, Goddard GR, Jenkins TM, Sauser JA, Gerrein BT, Rymeski BA. Primary Placement of a Low-Profile Gastrostomy Button Is Safe and Associated With Improved Outcomes in Children. J Surg Res 2020; 249:156-162. [DOI: 10.1016/j.jss.2019.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 12/23/2022]
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