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Wong JMW, Ludwig DS, Allison DB, Baidwan N, Bielak L, Chiu CY, Dickinson SL, Golzarri-Arroyo L, Heymsfield SB, Holmes L, Jansen LT, Lesperance D, Mehta T, Sandman M, Steltz SK, Wong WW, Yu S, Ebbeling CB. Design and conduct of a randomized controlled feeding trial in a residential setting with mitigation for COVID-19. Contemp Clin Trials 2024; 140:107490. [PMID: 38458559 DOI: 10.1016/j.cct.2024.107490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Evaluating effects of different macronutrient diets in randomized trials requires well defined infrastructure and rigorous methods to ensure intervention fidelity and adherence. METHODS This controlled feeding study comprised two phases. During a Run-in phase (14-15 weeks), study participants (18-50 years, BMI, ≥27 kg/m2) consumed a very-low-carbohydrate (VLC) diet, with home delivery of prepared meals, at an energy level to promote 15 ± 3% weight loss. During a Residential phase (13 weeks), participants resided at a conference center. They received a eucaloric VLC diet for three weeks and then were randomized to isocaloric test diets for 10 weeks: VLC (5% energy from carbohydrate, 77% from fat), high-carbohydrate (HC)-Starch (57%, 25%; including 20% energy from refined grains), or HC-Sugar (57%, 25%; including 20% sugar). Outcomes included measures of body composition and energy expenditure, chronic disease risk factors, and variables pertaining to physiological mechanisms. Six cores provided infrastructure for implementing standardized protocols: Recruitment, Diet and Meal Production, Participant Support, Assessments, Regulatory Affairs and Data Management, and Statistics. The first participants were enrolled in May 2018. Participants residing at the conference center at the start of the COVID-19 pandemic completed the study, with each core implementing mitigation plans. RESULTS Before early shutdown, 77 participants were randomized, and 70 completed the trial (65% of planned completion). Process measures indicated integrity to protocols for weighing menu items, within narrow tolerance limits, and participant adherence, assessed by direct observation and continuous glucose monitoring. CONCLUSION Available data will inform future research, albeit with less statistical power than originally planned.
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Affiliation(s)
- Julia M W Wong
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - David B Allison
- Indiana University School of Public Health, Bloomington, IN, United States of America
| | - Navneet Baidwan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States of America
| | - Lisa Bielak
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America
| | - Chia-Ying Chiu
- Division of Pulmonary, Allergy, and Acute Critical Care, Department of Medicine, University of Alabama at Birmingham, United States of America
| | - Stephanie L Dickinson
- Indiana University School of Public Health, Bloomington, IN, United States of America
| | | | - Steven B Heymsfield
- Metabolism & Body Composition Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, United States of America
| | - Lauren Holmes
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America
| | - Lisa T Jansen
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Donna Lesperance
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America
| | - Tapan Mehta
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, United States of America
| | - Megan Sandman
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America
| | - Sarah K Steltz
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America
| | - William W Wong
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States of America
| | - Shui Yu
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America
| | - Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America.
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Touré I, Maitre G, Boillat L, Chanez V, Natterer J, Ferry T, Longchamp D, Perez MH. Implementing a physician-driven feeding protocol is not sufficient to achieve adequate caloric and protein delivery in a paediatric intensive care unit: A retrospective cohort study. Clin Nutr ESPEN 2023; 55:384-391. [PMID: 37202072 DOI: 10.1016/j.clnesp.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Daily caloric and protein intake is crucial for the management of critically ill children. The benefit of feeding protocols in improving daily nutritional intake in children remains controversial. This study aimed to assess whether the introduction of an enteral feeding protocol in a paediatric intensive care unit (PICU) improves daily caloric and protein delivery on day 5 after admission and the accuracy of the medical prescription. METHODS Children admitted to our PICU for a minimum of 5 days who received enteral feeding were included. Daily caloric and protein intake were recorded and retrospectively compared before and after the introduction of the feeding protocol. RESULTS Caloric and protein intake was similar before and after introduction of the feeding protocol. The prescribed caloric target was significantly lower than the theoretical target. The children who received less than 50% of the caloric and protein targets were significantly heavier and taller than those who received more than 50%; the patients who received more than 100% of the caloric and protein aims on day 5 after admission had a decreased PICU length of stay and decreased duration of invasive ventilation. CONCLUSION The introduction of a physician-driven feeding protocol was not associated with an increase in the daily caloric or protein intake in our cohort. Other methods of improving nutritional delivery and patient outcomes need to be explored.
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Affiliation(s)
- Ismael Touré
- Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
| | - Guillaume Maitre
- Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
| | - Laurence Boillat
- Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
| | - Vivianne Chanez
- Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
| | - Julia Natterer
- Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
| | - Thomas Ferry
- Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
| | - David Longchamp
- Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
| | - Maria-Helena Perez
- Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
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Raduma OS, Jehangir S, Karpelowsky J. The effect of standardized feeding protocol on early outcome following gastroschisis repair: A systematic review and meta-analysis. J Pediatr Surg 2021; 56:1776-1784. [PMID: 34193345 DOI: 10.1016/j.jpedsurg.2021.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Improved post-operative outcomes following gastroschisis repair are attributed to advancement in perioperative and post-operative care and early enteral feeding. This study evaluates the role of standardized postoperative feeding protocols in gastroschisis. STUDY DESIGN A systematic review and meta-analysis of studies published from January 2000 to April 2019 in MEDLINE, EMBASE, Cochrane Library databases and Google Scholar was conducted. Primary outcomes were duration to full enteral feeding and cessation of parenteral nutrition. Secondary outcomes included days to first enteral feeding, length of stay, compliance, complication and mortality rates. Meta-analysis was done using the RevMan Analysis Statistical Package in Review Manager (Version 5.3) using a random effects model and reported as pooled Risk Ratio and Mean Difference. p-value < 0.05 was considered statistically significant. RESULTS Eight observational cohort studies were identified and their data analyzed. Significant heterogeneity was noted for some outcomes. Standardized feeding protocols resulted in fewer days to first enteral feeding by 3.19 days (95% CI: -4.73, -1.66, p < 0.0001) than non-protocolized feeding, less complication rates, reduced mortality and better compliance to care. The duration of parenteral nutrition and time to full enteral feeding were not significantly affected. CONCLUSION Protocolized feeding post-gastroschisis repair is associated with early initiation of enteral feeding. There is a likelihood of reduced rates of sepsis; shorter duration of parenteral nutrition, length of hospital stay and time to full enteral feeding. However, the latter trends are not statistically significant and will require further studies best accomplished with a prospective randomized trial or more cohort studies.
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Affiliation(s)
- Ochieng Sephenia Raduma
- Department of Surgery, Defence Forces Memorial Hospital, Nairobi, Kenya; Division of Surgery, University of Sydney, NSW, Australia; Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia
| | - Susan Jehangir
- Department of Paediatric Surgery, The Children's hospital at Westmead, NSW, Australia; Christian Medical College, Vellore, Tamil Nadu, India
| | - Jonathan Karpelowsky
- Division of Surgery, University of Sydney, NSW, Australia; Department of Paediatric Surgery, The Children's hospital at Westmead, NSW, Australia; Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia.
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Gilannejad N, Rønnestad I, Lai F, Olderbakk-Jordal AE, Gottlieb Almeida AP, Martínez-Rodríguez G, Moyano FJ, Yúfera M. Daily rhythms of intestinal cholecystokinin and pancreatic proteases activity in Senegalese sole juveniles with diurnal and nocturnal feeding. Comp Biochem Physiol A Mol Integr Physiol 2020; 253:110868. [PMID: 33316387 DOI: 10.1016/j.cbpa.2020.110868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
Abstract
The influence of diurnal and nocturnal feeding on daily rhythms of gut levels of cholecystokinin (CCK) and the activity of two key pancreatic proteases, trypsin and chymotrypsin, were examined in juveniles of Senegalese sole (Solea senegalensis), a species with nocturnal habits. Four feeding protocols were performed: P1) One morning meal; P2) Six meals during the light period; P3) Six meals during the dark period; and P4) 12 meals during 24 h. Daily activity patterns of both proteases were remarkably similar and showed a high correlation in all the experimental protocols. In P1, daily patterns of CCK and digestive enzymes showed a single maximum. In P2, CCK levels exhibited two peaks. Digestive enzymes activities showed slightly delayed peaks compared to CCK, although their daily fluctuations were not significant. In P3, intestinal CCK concentration exhibited two peaks at the end of light and dark periods, but only the second one was significant. The first maximum level of chymotrypsin activity occurred 4 h after the first CCK peak, while the second one coincided with the second CCK peak. Fluctuations of trypsin activity were not significant. In P4, CCK concentration showed three small peaks. Digestive enzymes daily fluctuations were not significant, although they showed an inverted trend with respect to CCK. The daily pattern of the gut CCK content in our study is in agreement with the anorexigenic function of this hormone. Our results support the existence of a negative feedback regulatory loop between CCK and pancreatic proteolytic enzymes in Senegalese sole juveniles.
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Affiliation(s)
- Neda Gilannejad
- Instituto de Ciencias Marinas de Andalucía (ICMAN-CSIC), 11519 Puerto Real, Cádiz, Spain.
| | - Ivar Rønnestad
- Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - Floriana Lai
- Department of Biological Sciences, University of Bergen, Bergen, Norway
| | | | | | | | - Francisco J Moyano
- Depto. de Biología y Geología, Facultad de Ciencias, Campus de Excelencia Internacional del Mar (CEI-MAR), Universidad de Almería, 04120 Almería, Spain
| | - Manuel Yúfera
- Instituto de Ciencias Marinas de Andalucía (ICMAN-CSIC), 11519 Puerto Real, Cádiz, Spain
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Ebbeling CB, Klein GL, Luoto PK, Wong JMW, Bielak L, Eddy RG, Steltz SK, Devlin C, Sandman M, Hron B, Shimy K, Heymsfield SB, Wolfe RR, Wong WW, Feldman HA, Ludwig DS. A randomized study of dietary composition during weight-loss maintenance: Rationale, study design, intervention, and assessment. Contemp Clin Trials 2018; 65:76-86. [PMID: 29233719 PMCID: PMC6055230 DOI: 10.1016/j.cct.2017.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND While many people with overweight or obesity can lose weight temporarily, most have difficulty maintaining weight loss over the long term. Studies of dietary composition typically focus on weight loss, rather than weight-loss maintenance, and rely on nutrition education and dietary counseling, rather than controlled feeding protocols. Variation in initial weight loss and insufficient differentiation among treatments confound interpretation of results and compromise conclusions regarding the weight-independent effects of dietary composition. The aim of the present study was to evaluate three test diets differing in carbohydrate-to-fat ratio during weight-loss maintenance. DESIGN AND DIETARY INTERVENTIONS Following weight loss corresponding to 12±2% of baseline body weight on a standard run-in diet, 164 participants aged 18 to 65years were randomly assigned to one of three test diets for weight-loss maintenance through 20weeks (test phase). We fed them high-carbohydrate (60% of energy from carbohydrate, 20% fat), moderate-carbohydrate (40% carbohydrate, 40% fat), and low-carbohydrate (20% carbohydrate, 60% fat) diets, controlled for protein content (20% of energy). During a 2-week ad libitum feeding phase following the test phase, we assessed the effect of the test diets on body weight. OUTCOMES The primary outcome was total energy expenditure, assessed by doubly-labeled water methodology. Secondary outcomes included resting energy expenditure and physical activity, chronic disease risk factors, and variables to inform an understanding of physiological mechanisms by which dietary carbohydrate-to-fat ratio might influence metabolism. Weight change during the ad libitum feeding phase was conceptualized as a proxy measure of hunger.
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Affiliation(s)
- Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Gloria L Klein
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Patricia K Luoto
- Department of Food and Nutrition, Framingham State University, 100 State Street, PO Box 9101, Framingham, MA 01701, United States
| | - Julia M W Wong
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Lisa Bielak
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Ralph G Eddy
- Sodexo Inc., Framingham State University, 100 State Street, PO Box 9101, Framingham, MA 01701, United States
| | - Sarah K Steltz
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Courtenay Devlin
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Megan Sandman
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Bridget Hron
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Division of Gastroenterology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Kim Shimy
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
| | - Robert R Wolfe
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - William W Wong
- Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, 1100 Bates Street, Houston, TX 77030, United States
| | - Henry A Feldman
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - David S Ludwig
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
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Gephart SM, Wyles C, Canvasser J. Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants. Appl Nurs Res 2017; 39:182-188. [PMID: 29422156 DOI: 10.1016/j.apnr.2017.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/15/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Necrotizing enterocolitis (NEC) is a catastrophic abdominal complication threatening the life of premature infants, but adoption of prevention and early recognition practices differs as do NEC rates in Neonatal Intensive Care Units (NICUs). The purpose of this research was to validate and weight an evidence-based adherence score (aka NEC-Zero Adherence Score) to prevent and foster timely recognition of NEC. STUDY DESIGN An electronic Delphi (e-Delphi) approach was used to identify consensus. NEC experts were recruited via the NEC Society and surveyed until consensus and stability criteria for the Delphi were met (≥70% consensus and mean responses changed <15% between rounds). RESULTS Expert panelists (n=22) were experienced (M=17.6, SD 11years) and predominately physicians (68%) or neonatal nurse practitioners (18%). Consensus (>70% by item) supported a 10 point score. Points were distributed across 1) an exclusive human milk diet (5 points), 2) standardized feeding protocols (3 points), 3) antibiotic stewardship (1 point), and 4) a unit-specified approach to early recognition (1 point). Withholding feeding during transfusion was controversial (M=0.50, SD 0.73) and met consensus criteria to drop from the score. CONCLUSIONS Holding feeding during transfusion was dropped from the score. Relationships between the score and unit NEC rates as well as its utility for use in audit and feedback should be studied in the future.
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Affiliation(s)
- Sheila M Gephart
- The University of Arizona College of Nursing, Tucson, AZ, United States.
| | - Christina Wyles
- The University of Arizona College of Nursing, Tucson, AZ, United States
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Padar M, Uusvel G, Starkopf L, Starkopf J, Reintam Blaser A. Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study. World J Crit Care Med 2017; 6:56-64. [PMID: 28224108 PMCID: PMC5295170 DOI: 10.5492/wjccm.v6.i1.56] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/08/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.
METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit (ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012 (the Before group) and 2014-2015 (the After group) were obtained from a local electronic database, the national Population Registry and the hospital’s Infection Control Service. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed.
RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group (86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospital-acquired infections, length of ICU stay and ICU, 30- and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d (P = 0.026) and 120-d (P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently (P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally (P = 0.049) and a lower cumulative amount of parenterally (P < 0.001) provided calories by day 7, with an overall reduction in caloric provision (P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding (total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After (P < 0.001). Inclusion in the Before group, previous abdominal surgery, intra-abdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.
CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.
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Carpenito KR, Prusinski R, Kirchner K, Simsic J, Miao Y, Luce W, Cheatham JP, Galantowicz M, Backes CH, Cua CL. Results of a Feeding Protocol in Patients Undergoing the Hybrid Procedure. Pediatr Cardiol 2016; 37:852-9. [PMID: 26921065 DOI: 10.1007/s00246-016-1359-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/13/2016] [Indexed: 12/13/2022]
Abstract
Neonates with single-ventricle physiology are at increased risk of developing gastrointestinal morbidities. Feeding protocols in this patient population have been shown to decrease feeding complications after the Norwood procedure, but no data exist to determine the effectiveness of a feeding protocol in patients undergoing the hybrid procedure. Goal of this study was to examine the impact of a standardized feeding protocol on the incidence of overall postoperative gastrointestinal morbidity after the hybrid procedure. Retrospective chart review was performed on neonates undergoing the hybrid procedure. Neonates were divided into two groups, pre-feeding protocol (pre-FP), which encompassed the years 2002-2008, and post-feeding protocol (post-FP), which encompassed the years 2011-2014. Preoperative, operative, and postoperative data were collected. T test or Fisher's exact test was used for analysis. p < 0.05 was considered significant. Seventy-three neonates were in the pre-FP and 52 neonates were in the post-FP. There were no significant differences between the pre-FP and the post-FP in cardiac diagnosis (62 HLHS, 11 other vs. 39 HLHS, 13 other, respectively). Pre-FP underwent hybrid procedure later than the post-FP (9.1 ± 5.8 vs. 5.7 ± 3.4 days, respectively, p < 0.01) and achieved full enteral feeds earlier than the post-FP (3.2 + 2.9 vs. 7.8 + 3.9 days, respectively, p < 0.01). The incidence of necrotizing enterocolitis was higher in the pre-FP versus post-FP [11.0 % (8/65) vs. 5.8 % (3/49), respectively, p = 0.36]. Though not significant, the incidence of necrotizing enterocolitis decreased by almost 50 % after initiating a feeding protocol in patients undergoing the hybrid procedure. This is consistent with previous studies showing beneficial results of a feeding protocol in this complex patient population.
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