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Velly Miguel M, Haubrick K. Systematic review: exploring outcomes of commercial and homemade blenderized tube-feeding regimens on feeding tolerance in pediatric patients. Nutr Rev 2024; 82:1208-1215. [PMID: 37791488 DOI: 10.1093/nutrit/nuad118] [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] [Indexed: 10/05/2023] Open
Abstract
CONTEXT Increasing numbers of patients and caregivers are requesting transition to blenderized tube feeding. There is a lack of systematic reviews addressing the outcomes of blenderized tube feeding. OBJECTIVE The aim was to evaluate the association of blenderized tube feeding on feeding tolerance in enterally fed pediatric patients. DATA SOURCES A literature search for articles from 2012-2022 using PubMed, Medline, Embase, and CINAHL yielded 78 articles. DATA EXTRACTION A description and evaluation of the study's sample, purpose, and results were summarized for 9 studies using the Academy of Nutrition and Dietetics Evidence Analysis Library Worksheet. DATA ANALYSIS Nine studies were evaluated using the Evidence Analysis Library Quality Criteria checklist. CONCLUSIONS Studies demonstrated an improvement in vomiting (n = 7), gagging/retching and heartburn (n = 6), abdominal pain/upset and distension (n = 3), and diarrhea (n = 6) with blenderized tube feeding. The outcomes of blenderized tube feeding on gas (n = 5) and constipation (n = 9) are variable and remain unclear. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022369247.
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Affiliation(s)
- Mariana Velly Miguel
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
- Food and Nutrition, Clinical Nutrition, Texas Children's Hospital, Houston, TX, USA
| | - Kevin Haubrick
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
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2
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Imdad A, Sherwani R, Wall K. Pediatric Formulas: An Update. Pediatr Rev 2024; 45:394-405. [PMID: 38945989 DOI: 10.1542/pir.2023-006002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 07/02/2024]
Abstract
The recent shortage of pediatric formulas in the United States, caused by supply chain issues and contamination of formula products in 1 of the major manufacturing plants, led many families to seek an alternate formula for their children. The Food and Drug Administration (FDA) allowed import of infant formulas from selected European and non-European countries. The European infant formulas differ from those produced in the United States regarding the primary source of the formula, age category, mixing instructions, labeling requirements, and formula composition in terms of macronutrients and micronutrients. Although most European infant formulas are nutritionally adequate, pediatricians and families need to be aware of the differences between the European and FDA-regulated formulas for their correct use and preparation for infants and young children. Supplementation with cow milk is recommended for children beyond infancy, and older infant formulas are not recommended for otherwise healthy growing children. However, pediatric formulas have been used to support the nutrition needs of children with feeding difficulties, especially those dependent on tube feeding and with certain medical conditions. The FDA does not regulate the production of pediatric formulas beyond infant formula, and significant variations exist in their composition. The pediatric formulas are available as polymeric (intact), hydrolyzed, elemental, or food-based blenderized formulas. The plant-based nonformula (milk) drinks are being used increasingly for children. These products might not be nutritionally complete and should be avoided in infants and children dependent on liquid nutrition.
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Affiliation(s)
- Aamer Imdad
- Division of Gastroenterology, Hepatology, Pancreatology, and Nutrition, Department of Pediatrics, Stead Family Children's Hospital, University of Iowa, Iowa City, IA
| | - Rida Sherwani
- Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY
| | - Kellie Wall
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY
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Verheije R, Carbone F, Bosmans T, Van Scheppingen L, van Hoeve K, Hoffman I. Exploring parental thoughts and clinical experiences on blended food in a paediatric population, a qualitative study. Acta Gastroenterol Belg 2024; 87:241-254. [PMID: 39210756 DOI: 10.51821/87.2.12122] [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] [Indexed: 09/04/2024]
Abstract
Background There's a growing interest in blended food (BF) as an alternative to commercial food (CF) for tube-fed children. Thus, we investigated parental and medical experiences with BF as an option for tube feeding in children. Methods In this cross-sectional study, all patients were already using BF, chosen by parents. In March 2022, all patients using BF provided consent and completed a questionnaire assessing their experiences. Medical data were collected retrospectively from patient charts, including biometric changes, dietary adjustments, and nutritional status. A non-validated parent satisfaction score was computed from 17 questions, rated on a scale from one to five. A score of ≥ 51 points, indicating an average score of > 3 per question, was deemed indicative of a positive parental experience with BF. Results Nine children receiving BF were identified (median age: 4.7 years; weight: 14.9 kg; 66% male). All parents were satisfied with BF, reflected in the parent satisfaction score. Parents cited reduced feeding-related discomforts as the main reason for switching to BF. Weight (+0.3 SD) and length (+0.5 SD) showed positive changes. None discontinued BF, though modifications were made for five patients by the dietician. Nutritional deficiencies, mainly iron with or without zinc deficiency, were observed in four patients, with uncertain onset due to lack of pre-BF laboratory testing. Conclusions In this small BF cohort overseen by an experienced multidisciplinary team, BF was well tolerated, resulting in high parental satisfaction and maintaining good nutritional status.
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Affiliation(s)
- R Verheije
- University Hospitals Gasthuisberg Leuven and KU Leuven, Belgium
| | - F Carbone
- University Hospitals Gasthuisberg Leuven, Belgium
| | - T Bosmans
- University Hospitals Gasthuisberg Leuven and KU Leuven, Belgium
| | | | - K van Hoeve
- University Hospitals Gasthuisberg Leuven and KU Leuven, Belgium
| | - I Hoffman
- University Hospitals Gasthuisberg Leuven and KU Leuven, Belgium
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Chloupek A, Jurkiewicz D. The Effect of Hospital-Based Liquid Diet and Commercial Formulas on Laboratory Parameters and Postoperative Complications in Patients with Head and Neck Cancer. J Clin Med 2024; 13:1844. [PMID: 38610609 PMCID: PMC11012823 DOI: 10.3390/jcm13071844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Patients with head and neck cancer (HNC) are at high risk of malnutrition. The aim of this study was to compare the effect of polymeric formulas available commercially and a high-protein liquid diet prepared in the hospital on laboratory parameters and postoperative complications in patients undergoing surgery for HNC. Methods: This single-center retrospective study included 149 patients who underwent surgery for HNC between 2008 and 2017. The following data were collected: patient and tumor characteristics, postoperative complications, and laboratory parameters measured at baseline and after surgery, including creatinine, alanine transaminase (ALT), aspartate transaminase (AST), and blood glucose levels. Correlations between the duration of enteral nutrition and blood parameters were assessed. Results: After surgery, patients receiving commercial formulas had lower creatinine and blood glucose levels and higher ALT and ASP levels than those on the hospital-based diet. The longer duration of feeding with commercial formulas before surgery was associated with enhanced preoperative levels of ALT and ASP and with lower postoperative blood glucose. Patients on the hospital-based diet had a higher rate of postoperative complications than those receiving commercial formulas (16.1% vs. 3.3%). Conclusions: There were no clinically important differences in blood parameters among patients with HNC depending on the type of preparations used for enteral feeding. However, increased levels of liver enzymes in patients fed with commercial formulas were notable. The early initiation of enteral nutrition before surgery helped achieve normal blood glucose levels after surgery. The use of commercial preparations contributed to reducing the number and incidence of postoperative complications.
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Affiliation(s)
- Aldona Chloupek
- Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Oncology, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland;
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Walker S, Johnson TW, Carter H, Spurlock AY, Johnson K, Hussey J. Blenderized food tube feeding in very young pediatric patients with special healthcare needs. Nutr Clin Pract 2024; 39:202-209. [PMID: 36871186 DOI: 10.1002/ncp.10975] [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: 10/15/2022] [Revised: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Up to 85% of children with severe developmental disabilities have feeding disorders and require enteral tube feeding. Many caregivers desire blenderized tube feeding (BTF) instead of commercial formula (CF) for their child, citing a desire for a more physiologic feeding, to reduce gastrointestinal (GI) symptoms and/or promote oral intake. METHODS In this retrospective, single-center study, medical records (n = 34) of very young children (aged ≤36 months) with severe developmental disabilities were reviewed. Comparisons of growth parameters, GI symptoms, oral feeding, and GI medication use were made between the initial introduction of BTF and again at the last patient encounter when the children aged out of the program. RESULTS Of the 34 charts reviewed (16 male and 18 female patients), comparisons between baseline BTF introduction and the last patient encounter indicated reductions in adverse GI symptoms, significant GI medication reduction (P = 0.000), increased oral food intake, and nonsignificant improvements in growth parameters. These positive outcomes were realized whether children received full or partial BTF or type of BTF formulation. CONCLUSION Consistent with similar research studies, transitioning very young children with significant special healthcare needs from CF to BTF resulted in improvement in GI symptoms, reduced need for GI medications, supported growth goals, and contributed to improved oral feeding.
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Affiliation(s)
- Shawna Walker
- The Resource Exchange, Colorado Springs, Colorado, USA
| | - Teresa W Johnson
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Holly Carter
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Amy Y Spurlock
- School of Nursing, Boise State University, Boise, Idaho, USA
| | - Kelly Johnson
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Jenna Hussey
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
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Oftedal S, McCormack S, Stevenson R, Benfer K, Boyd RN, Bell K. The evolution of nutrition management in children with severe neurological impairment with a focus on cerebral palsy. J Hum Nutr Diet 2024. [PMID: 38196166 DOI: 10.1111/jhn.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Abstract
Nutritional management of children with severe neurological impairment (SNI) is highly complex, and the profile of this population is changing. The aim of this narrative review was to give the reader a broad description of evolution of the nutritional management of children with SNI in a high resource setting. In the last decade, there has been an emphasis on using multiple anthropometric measures to monitor nutritional status in children with SNI, and several attempts at standardising the approach have been made. Tools such as the Feeding and Nutrition Screening Tool, the Subjective Global Nutrition Assessment, the Eating and Drinking Ability Classification System and the Focus on Early Eating and Drinking Swallowing (FEEDS) toolkit have become available. There has been an increased understanding of how the gut microbiome influences gastrointestinal symptoms common in children with SNI, and the use of fibre in the management of these has received attention. A new diagnosis, 'gastrointestinal dystonia', has been defined. The increased use and acceptance of blended food tube feeds has been a major development in the nutritional management of children with SNI, with reported benefits in managing gastrointestinal symptoms. New interventions to support eating and drinking skill development in children with SNI show promise. In conclusion, as the life expectancy of people with SNI increases due to advances in medical and nutrition care, our approach necessitates a view to long-term health and quality of life. This involves balancing adequate nutrition to support growth, development and well-being while avoiding overnutrition and its associated detrimental long-term effects.
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Affiliation(s)
- Stina Oftedal
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Siobhan McCormack
- Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland
- Department of Paediatrics, School of Medicine, University of Galway, Galway, Ireland
| | - Richard Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Katherine Benfer
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
- Dietetics and Food Services, Children's Health Queensland, South Brisbane, Queensland, Australia
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Doyle C, Louw J, Shovlin A, Dowd L, Kavanagh M. Blended feeding in gastrostomy-fed children-A scoping review. Child Care Health Dev 2024; 50:e13222. [PMID: 38265135 DOI: 10.1111/cch.13222] [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: 06/23/2022] [Revised: 09/08/2023] [Accepted: 12/03/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Blended feeding has become increasingly prevalent in recent years with its practice gaining some momentum. With anecdotal reports of benefits and little evidence of harm in the literature regarding blended feeding, this scoping review was deemed important. The aim of this scoping review was to summarise the published evidence about blended feeding in gastrostomy-fed children. METHOD The scoping review methodology used included searches in specific online databases: PUBMED, PsychINFO, CINAHL, SCOPUS, AMED and EMBASE for articles that addressed issues pertaining to blended feeds in gastrostomy-fed children. Grey literature was also considered. Inclusion criteria included papers that pertained to information and research on blended feeding in gastrostomy-fed children. Studies published in English over the past 11 years (2011-2022) were included. This resulted in 59 papers being included in this scoping review. RESULTS Thematic analysis of the literature identified eight overall themes. It was clear that parents found blended feeding promoted the normalising of feeding, their own involvement in decision-making around foods and promotion of a socially inclusive mealtime. The need for dietician and health professional input and support is key, whereas a lack of guidelines acts as a barrier to blended feeding. Furthermore, risks associated with blended feeding are identified but also the benefits to the physical well-being of the child are considered. CONCLUSION The review was comprehensive in that it identified a broad range of literature, exploring the extent, range and nature of research activity related to the use of blended feeds. The lack of original research is a concern. However, it is expected this review will provide direction for researchers, and in particular inform policy and practitioners working in the field where blended feeds may be an option for gastrostomy-fed children.
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Affiliation(s)
- Carmel Doyle
- School of Nursing & Midwifery, Trinity College, Dublin, Ireland
| | - Julia Louw
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
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McCormack S, Patel K, Smith C. Blended diet for enteral tube feeding in young people: A systematic review of the benefits and complications. J Hum Nutr Diet 2023; 36:1390-1405. [PMID: 36692240 DOI: 10.1111/jhn.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Interest and use of blended diets (BD) for young people who are tube fed has significantly increased in the last decade, driven primarily by the desires of motivated caregivers. This review identified, appraised and synthesised the available evidence on the benefits and complications of BD versus commercial feeds. METHODS A systematic review following PRISMA guidance and registered with PROSPERO was conducted across PubMed, Embase, CINAHL, Scopus and Cochrane up to August 2022. INCLUSION CRITERIA English language studies including (1) children, (2) original research (interventional and observational) and (3) examination of BD outcomes. Exclusion criteria were (1) unoriginal research or case reports, (2) focus on feeding management, preparations or attitudes and (3) comparing commercial blends only. Data were synthesised using an established narrative synthesis approach using the Mixed Methods Appraisal Tool. RESULTS Eight hundred and six database results were identified and 61 were sought for retrieval. A full-text article review revealed seven eligible studies, involving 267 participants (age range 9 months to 26 years). Studies reported differences in gastrointestinal symptoms (n = 222), medication use (n = 119), growth (n = 189) and complications or adverse events (n = 91). The results indicate positive outcomes, particularly in gastrointestinal symptom control, with few reports of mild adverse events in the included studies. CONCLUSIONS There is a paucity of data in this area and much heterogeneity in the included studies, but the available literature points towards positive outcomes. This is an important and highly relevant topic, and more primary research, ideally using standardised reporting, is required to answer the key questions.
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Affiliation(s)
- Siobhan McCormack
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Kamal Patel
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Chris Smith
- Department of Paediatric Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
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9
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Krishnan U, Day AS. Advances in Nutrition in Pediatric Gastroenterology. Nutrients 2023; 15:2181. [PMID: 37432376 DOI: 10.3390/nu15092181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 07/12/2023] Open
Abstract
Chronic conditions affecting the gastrointestinal (GI) tract commonly impact nutrition adversely [...].
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Affiliation(s)
- Usha Krishnan
- Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, NSW 2031, Australia
- School Women's and Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Andrew S Day
- Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, NSW 2031, Australia
- School Women's and Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Paediatrics, University of Otago Christchurch, Christchurch 8011, New Zealand
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10
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Klepper CM, Moore J, Gabel ME, Fleet SE, Kassel R. Pediatric formulas: Categories, composition, and considerations. Nutr Clin Pract 2023; 38:302-317. [PMID: 36815542 DOI: 10.1002/ncp.10954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 02/24/2023] Open
Abstract
Formulas, liquid nutrition, may be consumed orally or via a feeding tube to provide partial or complete nutrition that a given individual could not obtain using natural food stuffs in their native form. A wide range of commercially available formulas exist, which may be used as sole-source nutrition or in conjunction with other foods. Physicians and dietitians must understand the nature of and indications for specific formulas to treat diseases, provide complete nutrition to patients, and avoid harm. Products vary in macronutrient and micronutrient content and calorie concentration among many other factors. They are formulated specifically for patients of specific ages, correlating to nutritional needs and medical diagnoses. Additionally, formula availability, insurance coverage, mode of consumption, physiologic tolerance, and caregiver preference influence formula selection. Caregivers may also make their own pediatric formulas. We review commercial and homemade pediatric formulas.
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Affiliation(s)
- Corie M Klepper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joseph Moore
- Department of Clinical Nutrition and Lactation, Children's of Alabama, Birmingham, Alabama, USA
| | - Megan E Gabel
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah E Fleet
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel Kassel
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.,Division of Gastroenterology, Hepatology and Nutrition, Birmingham, Alabama, USA
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Shrager S, Adigun A, Motolongo S, Santos CS, Rowe-King P, Duro D. Comparison of Home-Blenderized Formula and Commercial Enteral Formulas for Gastrostomy Tube-Fed Children: A Retrospective, Prospective Cohort Study. Cureus 2023; 15:e37944. [PMID: 37220453 PMCID: PMC10200265 DOI: 10.7759/cureus.37944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Background Blenderized gastrostomy tube feedings (BGTFs) consist of pureed table foods and liquids that are administered as enteral tube feedings. Compared to commercial enteral formulas (CEFs), BGTF has been shown to have fewer side effects. Despite these results, apprehensions have been raised about microbial contamination, nutritional deficiencies or surplus, risk of gastrostomy tube (GT) blockages, and lack of consistency in clinical outcomes. The goal of this retrospective, prospective, 18-month-long study is to report the clinical and nutritional outcomes of GT-dependent pediatric patients who attended a multidisciplinary feeding clinic. Methodology After Institutional Review Board (IRB) approval and consent were obtained, 25 children who were receiving tube feeding via G were enrolled in a retrospective, prospective, observational, cohort study from August 2019 to February 2021. A multidisciplinary team was formed, and multivariate logistic regression was performed comparing subjects on BGTF versus CEF, per os diet versus nil per os, CEF versus homemade blenderized tube feeding (HBTF) versus blenderized tube feeding (BTF), and how they compared at the beginning and end of the study. Results The mean age of the patients was 4.4 years (SD ±2.2). Gastroesophageal reflux disease (GERD) and short bowel syndrome (SBS) were the most common comorbid gastrointestinal (GI) conditions. Of the 25 patients enrolled in the study, seven were initially on BGTF, while 14 ended the study on BGTF. There were no statistically significant differences in malnutrition status, feeding intolerance, emergency room visits, hospitalizations, and GT blockages between all different comparison groups when comparing between the CEF versus HBTF versus commercial blenderized tube feeding (CBTF) groups. Of the patients who were in the BGTF group, there was a resolution of vitamin A deficiency, vitamin D deficiency, and anemia (n = 1). In total, two patients had resolved vitamin deficiencies, namely, vitamins A and D. Conclusions When comparing BGTF and CEF, there was no statistically significant difference in outcomes. This study suggests that BGTF is at least equivalent to CEF in clinical outcomes, meaning BGTF should be considered standard nutrition for GT-dependent patients.
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Affiliation(s)
- Sebastian Shrager
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Ayoola Adigun
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Sonia Motolongo
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Cristhiane S Santos
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Patricia Rowe-King
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Debora Duro
- Pediatric Gastroenterology, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
- Pediatrics, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
- Pediatrics, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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Corsello A, Scatigno L, Govoni A, Zuccotti G, Gottrand F, Romano C, Verduci E. Gut dysmotility in children with neurological impairment: the nutritional management. Front Neurol 2023; 14:1200101. [PMID: 37213895 PMCID: PMC10196023 DOI: 10.3389/fneur.2023.1200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Intestinal motility disorders represent a frequent problem in children with neurological impairment. These conditions are characterized by abnormal movements of the gut, which can result in symptoms such as constipation, diarrhea, reflux, and vomiting. The underlying mechanisms leading to dysmotility are various, and the clinical manifestations are often nonspecific. Nutritional management is an important aspect of care for children with gut dysmotility, as it can help to improve their quality of life. Oral feeding, when safe and in the absence of risk of ingestion or severe dysphagia, should always be encouraged. When oral nutrition is insufficient or potentially harmful, it is necessary to switch to an enteral by tube or parenteral nutrition before the onset of malnutrition. In most cases, children with severe gut dysmotility may require feeding via a permanent gastrostomy tube to ensure adequate nutrition and hydration. Drugs may be necessary to help manage gut dysmotility, such as laxatives, anticholinergics and prokinetic agents. Nutritional management of patients with neurological impairment often requires an individualized care plan to optimize growth and nutrition and to improve overall health outcomes. This review tries to sum up most significant neurogenetic and neurometabolic disorders associated with gut dysmotility that may require a specific multidisciplinary care, identifying a proposal of nutritional and medical management.
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Affiliation(s)
- Antonio Corsello
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Lorenzo Scatigno
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Annalisa Govoni
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Frédéric Gottrand
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, University of Lille, Lille, France
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Elvira Verduci
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
- Department of Health Science, University of Milan, Milan, Italy
- *Correspondence: Elvira Verduci,
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