RESUMEN

BACKGROUND: When sufficient maternal milk is not available, donor human milk or formula are the alternative forms of enteral nutrition for very preterm or very low-birthweight (VLBW) infants. Donor human milk may retain the non-nutritive benefits of maternal milk and has been proposed as a strategy to reduce the risk of necrotising enterocolitis (NEC) and associated mortality and morbidity in very preterm or VLBW infants. OBJECTIVES: To assess the effectiveness of donor human milk compared with formula for preventing NEC and associated morbidity and mortality in very preterm or VLBW infants when sufficient maternal milk is not available. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Maternity and Infant Care (MIC) database, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), from the earliest records to February 2024. We searched clinical trials registries and examined the reference lists of included studies. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing feeding with donor human milk versus formula in very preterm (< 32 weeks' gestation) or VLBW (< 1500 g) infants. DATA COLLECTION AND ANALYSIS: Two review authors evaluated the risk of bias in the trials, extracted data, and synthesised effect estimates using risk ratio, risk difference, and mean difference, with associated 95% confidence intervals. The primary outcomes were NEC, late-onset invasive infection, and all-cause mortality before hospital discharge. The secondary outcomes were growth parameters and neurodevelopment. We used the GRADE approach to assess the certainty of the evidence for our primary outcomes. MAIN RESULTS: Twelve trials with a total of 2296 infants fulfilled the inclusion criteria. Most trials were small (average sample size was 191 infants). All trials were performed in neonatal units in Europe or North America. Five trials were conducted more than 40 years ago; the remaining seven trials were conducted in the year 2000 or later. Some trials had methodological weaknesses, including concerns regarding masking of investigators and selective reporting. Meta-analysis showed that donor human milk reduces the risk of NEC (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.37 to 0.76; I² = 4%; risk difference (RD) -0.03, 95% CI -0.05 to -0.01; 11 trials, 2261 infants; high certainty evidence). Donor human milk probably has little or no effect on late-onset invasive infection (RR 1.12, 0.95 to 1.31; I² = 27%; RD 0.03, 95% CI -0.01 to -0.07; 7 trials, 1611 infants; moderate certainty evidence) or all-cause mortality (RR 1.00, 95% CI 0.76 to 1.31; I² = 0%; RD -0.00, 95% CI -0.02 to 0.02; 9 trials, 2116 infants; moderate certainty evidence). AUTHORS' CONCLUSIONS: The evidence shows that donor human milk reduces the risk of NEC by about half in very preterm or VLBW infants. There is probably little or no effect on late-onset invasive infection or all-cause mortality before hospital discharge.

Asunto(s)

Enterocolitis Necrotizante , Recién Nacido de muy Bajo Peso , Leche Humana , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Enterocolitis Necrotizante/prevención & control , Recién Nacido , Recien Nacido Prematuro , Fórmulas Infantiles , Enfermedades del Prematuro/prevención & control , Enfermedades del Prematuro/mortalidad , Nutrición Enteral/métodos , Recien Nacido Extremadamente Prematuro , Sesgo

RESUMEN

OBJECTIVE: To evaluate the impact of educational intervention on the occurrence of factors that interfere with the caloric-protein supply to critical and non-critical patients undergoing enteral nutritional therapy. METHOD: This is an intervention, a field experiment without a control group, carried out in a teaching hospital in Juiz de Fora, Minas Gerais, Brazil. Three training cycles were carried out with nursing professionals over 57 weeks, covering the same content. The data collected were divided into pre-intervention and intervention periods. Interference in caloric-protein support was analyzed based on the evaluation of days with non-conforming nutritional supply and the occurrence of factors that led to non-conformities. RESULTS: Following interventions, there was a significant reduction (p < 0.05) in the number of non-conforming and inadequate days (nutritional supply < 80%), the frequency of occurrence of interfering factors and non-conformities caused by failure to follow the vomiting protocol. CONCLUSION: The educational intervention was an effective strategy to increase the quality of the therapy evaluated, especially from the fifth day of enteral nutritional therapy onwards.

Asunto(s)

Nutrición Enteral , Nutrición Enteral/métodos , Humanos , Brasil , Femenino , Masculino , Hospitales de Enseñanza , Adulto , Persona de Mediana Edad , Ingestión de Energía

RESUMEN

Currently, severe combined abdominal trauma ranks third among all causes of mortality In Russia, second only to cardiovascular and oncologic diseases. In the period from 2019 to 2020 in our country, a slight decrease in traumatism is noted due to a decrease in the number of traffic accidents as the main cause of combined and multiple trauma. The number of abdominal injuries from the total number of injuries In Russian regions ranges from 1.5 to 36.5% and is accompanied by a high level of disability (25-80% in combined trauma and 5-8% in isolated trauma). Despite modern medical advances, lethality in combined trauma of abdominal organs varies from 10.7 to 69.7%, with closed abdominal trauma accounting for up to 6% of fatal outcomes. OBJECTIVE: Improving treatment outcomes in patients with closed abdominal trauma through comprehensive diagnosis of SCN and optimization of enteral therapy in patients with closed abdominal trauma. MATERIAL AND METHODS: The study included 40 patients (29 (72.5%) men and 11 (27.5%) women), who underwent examination and treatment at the State Budgetary Institution "Research Institute of SP. Im. N.V. Sklifosovsky Research Institute of St. Petersburg State Medical Center with the diagnosis: Closed abdominal trauma. The age of the patients varied from 25 to 81 years (Mean age was 49.6±13.1). To evaluate the effectiveness of intensive therapy, the patients were divided into 2 groups: the comparison group (n=26) included patients who were treated with complex conservative therapy. Patients of the main group (n=14) conservative therapy was supplemented with the use of ER to restore the functional activity of the intestine under the control of ultrasound and assessment of the degree of intra-abdominal hypertension, as well as with Intestamine to stimulate the intestinal trauma. RESULTS: In the course of the study it was found that, as a result of complex enteral therapy in the patients of the main group, starting from the 7th day of stay in the ORIT, positive dynamics was observed, consisting in a statistically significant decrease in the levels of lactate, ALT, AST, LDH, and CRP. By the 14th day there was also a statistically significant decrease in leukocyte and PCT levels. The lethality in the main group amounted to 7.2%, n=1. At the same time, in patients of the comparison group only by the 7th day there was a decrease in concentration of CRP (p=0.065), by the 10th day - ALT (<0.001) and by the 14th day there was a decrease in leukocytes level (p=0.038). Lethality in this group amounted to 23.1%, n=6. CONCLUSION: Timely initiation of pathogenetic enteral therapy contributes to faster normalization of clinical and laboratory parameters, protection of intestinal barrier function, prevention of complications associated with bacterial translocation and bacterial overgrowth syndrome, increase in immunoresistance of the organism.

Asunto(s)

Traumatismos Abdominales , Heridas no Penetrantes , Humanos , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/terapia , Masculino , Femenino , Persona de Mediana Edad , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/terapia , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/fisiopatología , Federación de Rusia/epidemiología , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/terapia , Traumatismo Múltiple/mortalidad , Adulto , Nutrición Enteral/métodos , Nutrición Enteral/estadística & datos numéricos , Síndrome , Enfermedades Intestinales/diagnóstico , Enfermedades Intestinales/terapia

RESUMEN

INTRODUCTION: The main risk factors for major complications and early mortality after the positioning of percutaneous endoscopic gastrostomy (PEG) reported in the literature are old age, multimorbidity, and the use of inappropriate methods for PEG positioning. A proper PEG positioning technique and adequate post-positioning patient management and surveillance are the main protective factors, but the information on protective factors in the literature is much poorer. The aim of this study was to provide more information on PEG-related complications and mortality in geriatric patients treated with long-term enteral nutrition administered by PEG according to a specific home enteral nutrition (HEN) protocol. METHODS: This was a retrospective study based on data from 136 elderly patients in whom PEG was positioned from 2017 to 2023 at the geriatric hospital IRCCS INRCA, Ancona (Italy), 88 of whom were treated with HEN. Data on PEG-related complications, duration of HEN, hospitalizations, and mortality were analyzed. RESULTS: No complications were registered during or immediately after the PEG positioning. The prevalence of a major complication-buried bumper-was in the lower limit of the range reported in the literature (4.32%). The prevalence of minor complications such as peristomal leakage, inadvertent tube removal, and granulation tissue was higher than that reported in the literature (14.71%, 23.53%, 29.41%), while tube blockage and peristomal site infection were less frequent (8.82%, 38.23%). Three hospitalizations for PEG-related complications occurred. Both the all-cause 30-day mortality and within-two-months mortality were lower than those in the literature (1.92% and 3.84%). CONCLUSIONS: The impact of the risk factors recognized by the literature on complications and mortality could be probably mitigated by improving the PEG placement techniques and pre- and post-PEG placement patient management practices. Data on the prevalence of complications and mortality must be interpreted in correlation to this information.

Asunto(s)

Nutrición Enteral , Gastrostomía , Multimorbilidad , Humanos , Gastrostomía/métodos , Gastrostomía/efectos adversos , Estudios Retrospectivos , Femenino , Masculino , Anciano , Anciano de 80 o más Años , Nutrición Enteral/métodos , Nutrición Enteral/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Italia/epidemiología , Resultado del Tratamiento

RESUMEN

BACKGROUND: This is an updated and expanded version of the original Cochrane review, first published in 2014. Postoperative oral intake is traditionally withheld after major abdominal gynaecologic surgery until the return of bowel function. The concern is that early oral intake will result in vomiting and severe paralytic ileus, with subsequent aspiration pneumonia, wound dehiscence, and anastomotic leakage. However, clinical studies suggest that there may be benefits from early postoperative oral intake. Currently, gynaecologic surgery can be performed through various routes: open abdominal, vaginal, laparoscopic, robotic, or a combination. In this version, we included women undergoing major gynaecologic surgery through all of these routes, either alone or in combination. OBJECTIVES: To assess the effects of early versus delayed (traditional) initiation of oral intake of food and fluids after major gynaecologic surgery. SEARCH METHODS: On 13 June 2023, we searched the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, the citation lists of relevant publications, and two trial registries. We also contacted experts in the field for any additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared the effect of early versus delayed initiation of oral intake of food and fluids after major gynaecologic surgery, performed by abdominal, vaginal, laparoscopic, and robotic approaches. Early feeding was defined as oral intake of fluids or food within 24 hours post-surgery, regardless of the return of bowel function. Delayed feeding was defined as oral intake after 24 hours post-surgery, and only after signs of postoperative ileus resolution. Primary outcomes were: postoperative ileus, nausea, vomiting, cramping, abdominal pain, bloating, abdominal distension, need for postoperative nasogastric tube, time to the presence of bowel sounds, time to the first passage of flatus, time to the first passage of stool, time to the start of a regular diet, and length of postoperative hospital stay. Secondary outcomes were: infectious complications, wound complications, deep venous thrombosis, urinary tract infection, pneumonia, satisfaction, and quality of life. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed the risk of bias, and extracted the data. We calculated the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous data. We examined continuous data using the mean difference (MD) and a 95% CI. We tested for heterogeneity between the results of different studies using a forest plot of the meta-analysis, the statistical tests of homogeneity of 2 x 2 tables, and the I² value. We assessed the certainty of the evidence using GRADE methods. MAIN RESULTS: We included seven randomised controlled trials (RCTs), randomising 902 women. We are uncertain whether early feeding compared to delayed feeding has an effect on postoperative ileus (RR 0.49, 95% CI 0.21 to 1.16; I² = 0%; 4 studies, 418 women; low-certainty evidence). We are uncertain whether early feeding affects nausea or vomiting, or both (RR 0.94, 95% CI 0.66 to 1.33; I² = 67%; random-effects model; 6 studies, 742 women; very low-certainty evidence); nausea (RR 1.24, 95% CI 0.51 to 3.03; I² = 74%; 3 studies, 453 women; low-certainty evidence); vomiting (RR 0.83, 95% CI 0.52 to 1.32; I² = 0%; 4 studies, 559 women; low-certainty evidence), abdominal distension (RR 0.99, 95% CI 0.75 to 1.31; I² = 0%; 4 studies, 559 women; low-certainty evidence); need for postoperative nasogastric tube placement (RR 0.46, 95% CI 0.14 to 1.55; 3 studies, 453 women; low-certainty evidence); or time to the presence of bowel sounds (MD -0.20 days, 95% CI -0.46 to 0.06; I² = 71%; random-effects model; 3 studies, 477 women; low-certainty evidence). There is probably no difference between the two feeding protocols for the onset of flatus (MD -0.11 days, 95% CI -0.23 to 0.02; I² = 9%; 5 studies, 702 women; moderate-certainty evidence). Early feeding probably results in a slight reduction in the time to the first passage of stool (MD -0.18 days, 95% CI -0.33 to -0.04; I² = 0%; 4 studies, 507 women; moderate-certainty evidence), and may lead to a slightly sooner resumption of a solid diet (MD -1.10 days, 95% CI -1.79 to -0.41; I² = 97%; random-effects model; 3 studies, 420 women; low-certainty evidence). Hospital stay may be slightly shorter in the early feeding group (MD -0.66 days, 95% CI -1.17 to -0.15; I² = 77%; random-effects model; 5 studies, 603 women; low-certainty evidence). The effect of the two feeding protocols on febrile morbidity is uncertain (RR 0.96, 95% CI 0.75 to 1.22; I² = 47%; 3 studies, 453 women; low-certainty evidence). However, infectious complications are probably less common in women with early feeding (RR 0.20, 95% CI 0.05 to 0.73; I² = 0%; 2 studies, 183 women; moderate-certainty evidence). There may be no difference between the two feeding protocols for wound complications (RR 0.82, 95% CI 0.50 to 1.35; I² = 0%; 4 studies, 474 women; low-certainty evidence), or pneumonia (RR 0.35, 95% CI 0.07 to 1.73; I² = 0%; 3 studies, 434 women; low-certainty evidence). Two studies measured participant satisfaction and quality of life. One study found satisfaction was probably higher in the early feeding group, while the other study found no difference. Neither study found a significant difference between the groups for quality of life (P > 0.05). AUTHORS' CONCLUSIONS: Despite some uncertainty, there is no evidence to indicate harmful effects of early feeding following major gynaecologic surgery, measured as postoperative ileus, nausea, vomiting, or abdominal distension. The potential benefits of early feeding include a slightly faster initiation of bowel movements, a slightly sooner resumption of a solid diet, a slightly shorter hospital stay, a lower rate of infectious complications, and a higher level of satisfaction.

Asunto(s)

Procedimientos Quirúrgicos Ginecológicos , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Femenino , Factores de Tiempo , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Tiempo de Internación , Sesgo , Cuidados Posoperatorios/métodos , Náusea y Vómito Posoperatorios/etiología , Náusea y Vómito Posoperatorios/epidemiología , Ingestión de Alimentos , Nutrición Enteral/métodos , Seudoobstrucción Intestinal/etiología , Ingestión de Líquidos

RESUMEN

BACKGROUND AND AIMS: Previous randomized controlled trials (RCTs) comparing intermittent feeding versus continuous feeding used different methods, employed shorter fasting intervals, ignored patients' posture in bed during feeds, and showed mixed results. Prolonged fasting intervals are hypothesized to have several benefits. Additionally, there is evidence for more efficient gastric emptying in the right lateral position. In this multicenter RCT, we aimed to compare the effects of three-times-a-day gastric feeding while in the right lateral tilt position (intermittent postural feeding) versus standard continuous gastric feeding (standard feeding) on gastrointestinal intolerance and mortality among mechanically ventilated patients in ICU. METHODS: Adult ICU patients with gastric feeding tube in-situ and requiring invasive mechanical ventilation were randomized to either intermittent postural feeding group or to the standard feeding group. The feeding formula, target daily feed volume and posture turns were determined as per standard practice for all patients. Primary outcome was an incidence rate per 100 patient-days of gastrointestinal intolerance, a composite outcome of vomiting, diarrhea or constipation. Secondary outcomes were all-cause hospital mortality, gastrointestinal intolerance-free days, ventilator-free days, episodes of vomiting or diarrhea per patient, and mean diet volume ratio (diet received/diet prescribed). RESULTS: At five multidisciplinary ICUs, 120 mechanically ventilated, adult ICU patients (median age 65 years, 60% males) were randomly allocated to intermittent postural feeding (n = 61) and standard feeding (n = 59). The primary outcome did not differ between intermittent feeding arm versus standard arm (8.5, 95% confidence interval (CI): 5.9-11.8, versus 6.2, 95% CI: 4.1-9.1 per 100 patient-days; p = 0.23). Gastrointestinal intolerance-free days until day 14 were similar (6 [2-8] versus 5 [2-10]; p = 0.68) in both groups. Number of episodes per patient of vomiting, diarrhea, or constipation also did not differ in between groups. All-cause hospital mortality between intermittent feeding arm versus standard arm was 20% versus 31% (p = 0.17). There were no significant between-group differences in any of the other secondary outcomes. CONCLUSIONS: Intermittent gastric feeds delivered three-times-a-day while in the right lateral tilt position among mechanically ventilated patients was as well tolerated as the continuous enteral feeding. A definitive RCT to assess other clinically important outcomes is justified. TRIAL REGISTRATION: ACTRN12616000212459 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365526&isReview=true.

Asunto(s)

Nutrición Enteral , Unidades de Cuidados Intensivos , Respiración Artificial , Humanos , Nutrición Enteral/métodos , Masculino , Femenino , Persona de Mediana Edad , Respiración Artificial/métodos , Anciano , Postura/fisiología , Cuidados Críticos/métodos , Posicionamiento del Paciente/métodos , Mortalidad Hospitalaria , Vómitos , Diarrea

RESUMEN

BACKGROUND AND AIM: In patients with Diabetes Mellitus (DM), Enteral Nutrition (EN) is associated with less hyperglycemia and lower insulin requirements compared to Parenteral Nutrition (PN). The primary aim of this study was to assess changes in glycemic control (GC) in DM patients on EN therapy. The secondary objectives included evaluating the impact of the specialized formula on various clinical parameters and the tolerability of the nutritional formula by monitoring potential gastrointestinal side effects. METHODS: We report a case series on the effects of a Diabetes-Specific Formula (DSF) on GC, lipid profile (LP), and renal and hepatic function in a DM cohort receiving EN support. RESULTS: Twenty-two DM subjects with total dysphagia (thirteen men, nine women) on continuous EN were observed. The use of a DSF in EN was associated with an improvement in glycemic indices across all patients studied, leading to a reduction in average insulin demand. No hospitalizations were reported during the study period. CONCLUSION: The study demonstrated that the use of DSFs in a multi-dimensional home care management setting can improve glycemic control, reduce glycemic variability and insulin need, and positively impact the lipid profile of the DM cohort. The metabolic improvements were supported by the clinical outcomes observed.

Asunto(s)

Nutrición Enteral , Control Glucémico , Servicios de Atención de Salud a Domicilio , Insulina , Humanos , Masculino , Femenino , Nutrición Enteral/métodos , Anciano , Persona de Mediana Edad , Control Glucémico/métodos , Insulina/sangre , Glucemia/metabolismo , Alimentos Formulados , Diabetes Mellitus/terapia , Diabetes Mellitus/sangre , Diabetes Mellitus/dietoterapia , Lípidos/sangre , Anciano de 80 o más Años , Trastornos de Deglución/terapia , Trastornos de Deglución/dietoterapia

RESUMEN

BACKGROUND: Few primary studies have examined the impact of olfactory and gustatory stimulation on premature infants, and variability exists in reported outcomes. PURPOSE: To explore the effects of olfactory and gustatory stimulation on feeding outcomes in preterm infants. DATA SOURCES: A literature search was conducted in 4 databases (CENTRAL, PubMed, Embase, CINAHL) from the inception of the databases to May 2024. STUDY SELECTION: Randomized controlled trials (RCTs) or quasi-RCTs to explore the effects of olfactory and gustatory stimulation on feeding outcomes in preterm infants were included. DATA EXTRACTION: Two reviewers independently extracted data from the included studies and completed the form designed for data extraction. RESULTS: Eleven RCTs and quasi-RCTs comprising 1009 preterm infants were included. Meta-analysis found that olfactory and gustatory stimulation significantly shortened the time to reach full oral feeds ( days ) (mean difference [MD]: -2.52, 95% confidence interval [CI]: -3.88 to -1.16, P = .0003), while they had no significant differences in time to achieve full enteral feeds ( days ), postmenstrual age (PMA) at the removal of the nasogastric tube ( weeks ), weight at discharge ( grams ), weight gain ( grams ), head circumference at discharge ( cm ), length at discharge ( cm ), total duration of parenteral nutrition ( days ), necrotizing enterocolitis, hospitalization duration ( days ), PMA at discharge ( weeks ). IMPLICATIONS FOR PRACTICE AND RESEARCH: Large sample, multicenter studies are needed to demonstrate the effectiveness of olfactory and gustatory stimulation on feeding outcomes in preterm infants.

Asunto(s)

Nutrición Enteral , Recien Nacido Prematuro , Humanos , Recién Nacido , Nutrición Enteral/métodos , Olfato/fisiología , Gusto/fisiología , Aumento de Peso

RESUMEN

BACKGROUND: The efficacy of highly restrictive dietary therapies such as exclusive enteral nutrition (EEN) in the induction of remission in Crohn's disease (CD) are well established, however, ongoing issues exist with its poor palatability, restrictions, and adherence. The primary aim of this review is to evaluate the current evidence for the efficacy of exclusively solid food diets on the induction and maintenance of clinical and biochemical remission in CD. Secondary aims include impact on endoscopic healing and quality of life. METHODS: A systematic review of all randomised controlled trials (RCTs), open-label randomised trials and head-to-head clinical trials assessing solid food diet intervention in patients with active or inactive Crohn's disease was conducted. Studies included adult and paediatric patients with a verified disease activity index at baseline and follow up (Harvey Bradshaw Index, HBI; Crohn's disease activity index, CDAI and paediatric CDAI, PCDAI). Additional secondary endpoints varied between studies, including endoscopic and biochemical responses, as well as quality of life measures. Two authors independently performed critical appraisals of the studies, including study selection and risk of bias assessments. RESULTS: 14 studies were included for review, with several studies suggesting clinically significant findings. Clinical remission was achieved in a paediatric population undertaking the Mediterranean diet (MD) (moderate risk of bias). In adults, the Crohn's disease exclusion diet (CDED) was comparable to the CDED with partial enteral nutrition (PEN) diet in induction of remission (moderate risk of bias). A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet was also shown to decrease symptoms in patients with quiescent or mildly active CD (high risk of bias), however, this was not corroborated by other low FODMAP diet studies. CONCLUSIONS: There are promising outcomes for the MD and CDED in inducing clinical remission in mild to moderate CD. The results need to be interpreted with caution due to design limitations, including issues with combining outcomes among CD and UC patients, and small sample size. The current evidence for solid food dietary therapy in CD is limited by the lack of high quality studies and moderate to high bias. Future well designed studies are needed to confirm their efficacy.

Asunto(s)

Enfermedad de Crohn , Inducción de Remisión , Enfermedad de Crohn/dietoterapia , Enfermedad de Crohn/terapia , Humanos , Calidad de Vida , Nutrición Enteral/métodos , Adulto , Ensayos Clínicos Controlados Aleatorios como Asunto , Niño

RESUMEN

BACKGROUND: Peptide transporter 1 (PepT1) transports bacterial oligopeptide products and induces inflammation of the bowel. Nutritional peptides compete for the binding of intestinal bacterial products to PepT1. We investigated the mechanism of short-peptide-based enteral nutrition (SPEN) on the damage to the gut caused by the bacterial oligopeptide product muramyl dipeptide (MDP), which is transported by PepT1. The gut-lung axis is a shared mucosal immune system, and immune responses and disorders can affect the gut-respiratory relationship. METHODS AND RESULTS: Sprague-Dawley rats were gavaged with solutions containing MDP, MDP + SPEN, MDP + intact-protein-based enteral nutrition (IPEN), glucose as a control, or glucose with GSK669 (a NOD2 antagonist). Inflammation, mitochondrial damage, autophagy, and apoptosis were explored to determine the role of the PepT1-nucleotide-binding oligomerization domain-containing protein 2 (NOD2)-beclin-1 signaling pathway in the small intestinal mucosa. MDP and proinflammatory factors of lung tissue were explored to determine that MDP can migrate to lung tissue and cause inflammation. Induction of proinflammatory cell accumulation and intestinal damage in MDP gavage rats was associated with increased NOD2 and Beclin-1 mRNA expression. IL-6 and TNF-α expression and apoptosis were increased, and mitochondrial damage was severe, as indicated by increased mtDNA in the MDP group compared with controls. MDP levels and expression of proinflammatory factors in lung tissue increased in the MDP group compared with the control group. SPEN, but not IPEN, eliminated these impacts. CONCLUSIONS: Gavage of MDP to rats resulted in damage to the gut-lung axis. SPEN reverses the adverse effects of MDP. The PepT1-NOD2-beclin-1 pathway plays a role in small intestinal inflammation, mitochondrial damage, autophagy, and apoptosis.

Asunto(s)

Acetilmuramil-Alanil-Isoglutamina , Beclina-1 , Nutrición Enteral , Lesión Pulmonar , Proteína Adaptadora de Señalización NOD2 , Transportador de Péptidos 1 , Ratas Sprague-Dawley , Transducción de Señal , Animales , Transportador de Péptidos 1/metabolismo , Transportador de Péptidos 1/genética , Ratas , Beclina-1/metabolismo , Beclina-1/genética , Proteína Adaptadora de Señalización NOD2/metabolismo , Proteína Adaptadora de Señalización NOD2/genética , Transducción de Señal/efectos de los fármacos , Lesión Pulmonar/metabolismo , Masculino , Acetilmuramil-Alanil-Isoglutamina/farmacología , Nutrición Enteral/métodos , Apoptosis/efectos de los fármacos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/patología , Autofagia/efectos de los fármacos , Pulmón/metabolismo , Pulmón/patología , Pulmón/efectos de los fármacos , Inflamación/metabolismo

RESUMEN

BACKGROUND AND OBJECTIVES: The objective of this study was to examine the effects of nutritional therapy in adult patients with severe burns. METHODS AND STUDY DESIGN: Sixty adult patients with severe burns were enrolled. Data on nutritional intake through enteral nutrition (EN) or parenteral nutrition (PN) on days 7, 14, 21, and 28 post-injury were collected. Patients were divided into target and non-target groups according to whether their energy or protein intake reached the target. Age, length of ventilation, and total bilirubin (TBIL), albumin (ALB), prealbumin (pALB), and C-reactive protein (CRP) concentrations of patients were recorded. RESULTS: The percentage of protein targets with protein delivery was lower than that of energy target with energy delivery. The ratio of PN protein to total protein was lower than that of PN energy to total energy on days 7, 14, 21, and 28 (p<0.001, p<0.001, p=0.001, and p=0.003, respectively). Compared to the non-target group on day 21, the target group was younger, had lower TBIL on day 7, higher ALB and pALB on day 21, and lower CRP on day 14 (p=0.025, p=0.021, p=0.028, p=0.029, and p=0.049, respectively). Multivariate logistic regression analysis showed that older age and longer ventilation were independent risk factors in patients who did not meet the nutritional target on day 21 (p=0.026 and p=0.043, respectively). CONCLUSIONS: The protein intake of adult patients with severe burns was low. Compared to the non-target group, the target group had better laboratory test results. Older age and longer ventilation were independent risk factors for patients not meeting the nutritional target.

Asunto(s)

Quemaduras , Humanos , Quemaduras/terapia , Masculino , Femenino , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Ingestión de Energía , Nutrición Parenteral/métodos , Nutrición Enteral/métodos , Estado Nutricional , Proteína C-Reactiva/análisis , Prealbúmina/análisis , Prealbúmina/metabolismo , Proteínas en la Dieta/administración & dosificación , Anciano , Adulto Joven , Bilirrubina/sangre

RESUMEN

Malnutrition is an important risk factor for multiple organ dysfunction syndrome in the elderly (MODSE) and seriously affects the occurrence, progression and prognosis of MODSE. Shenling Baizhu Power (SBP), a classic formula from traditional Chinese medicine (TCM), when integrated with enteral nutrition, has been proven to be an effective clinical strategy for treating the patients of MODSE with malnutrition. This study aimed to investigate the metabolic changes during disease occurrence and SBP treatment, and to discover potential metabolic biomarkers for the diagnosis and efficacy evaluation. An untargeted metabolomics strategy based on UHPLC-Q-Orbitrap-HRMS was performed to reveal the differential serum metabolites between MODSE patients with malnutrition (n=59) and healthy controls (n=33), and those between patients treated with enteral nutrition (n=31) and SBP combined with enteral nutrition (n=28). Significantly different metabolites were identified and mapped onto the network of metabolic pathways to explore the metabolic disorders caused by the disease and the metabolic regulatory mechanism of SBP. Additionally, the area under the curve (AUC) of the potential biomarkers was investigated for predicting the disease and the efficacy of SBP. Sixty differential metabolites were identified between the disease and control groups, which were mainly related to amino acid metabolism, energy metabolism and carbohydrate metabolism. In the same way, 50 differential metabolites associated with SBP treatment were identified, which improved metabolic abnormalities in vivo mainly by regulating the above-mentioned metabolic pathways. Finally, 13 differential metabolites in common were selected as the potential biomarkers and the AUC value of each biomarker was within the range of 0.8-1.0, indicating that these biomarkers had high prediction accuracy for the diagnosis and efficacy evaluation of MODSE with malnutrition. This study demonstrates that serum metabolomics approaches based on the UHPLC-Q-Orbitrap-HRMS platform can be applied as a tool to reveal the metabolic changes induced by MODSE with malnutrition and SBP can play an important role in the clinical application.

Asunto(s)

Biomarcadores , Medicamentos Herbarios Chinos , Nutrición Enteral , Desnutrición , Metabolómica , Insuficiencia Multiorgánica , Humanos , Metabolómica/métodos , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/uso terapéutico , Medicamentos Herbarios Chinos/farmacología , Masculino , Anciano , Femenino , Insuficiencia Multiorgánica/etiología , Biomarcadores/sangre , Desnutrición/terapia , Desnutrición/sangre , Nutrición Enteral/métodos , Cromatografía Líquida de Alta Presión/métodos , Medicina Tradicional China/métodos , Anciano de 80 o más Años , Polvos , Persona de Mediana Edad , Estudios de Casos y Controles

RESUMEN

Background: Patients with severe dysphagia are usually fed using a nasogastric tube (NGT). Many patients who receive long-term NGT feeding are unable to obtain sufficient nutrients orally immediately after NGT removal. Thus, a transitional period involving oral diet training is required to transition from NGT feeding to exclusive oral feeding. We aimed to investigate the therapeutic effect of oral diet training in indwelling NGT patients with prolonged dysphagia. Methods: A total of 175 patients who were fed using an NGT for more than 4 weeks were enrolled. Their swallowing function was evaluated by a videofluoroscopic swallowing study (VFSS). During the VFSS, patients received thick and thin barium while the NGT was inserted. Then, the patients underwent a VFSS without an NGT thirty minutes after NGT removal. If a patient had no aspiration with NGT inserted during the VFSS, oral diet training combined with NGT feeding was recommended. Results: Of the 49 indwelling NGT patients who were recommended to receive oral diet training, 39 (79.6%) transitioned to exclusive oral feeding. A transition period of 2-8 weeks was required for them to achieve full oral feeding. Patients who were eligible for oral feeding trials showed no significant aspiration during the VFSS with an NGT inserted and had sufficient cough function. Patients who required prolonged NGT feeding and who could not complete oral trials showed significant aspiration during the VFSS when an NGT was inserted. Conclusions: This study demonstrated that oral diet training combined with NGT feeding is safe in patients with prolonged dysphagia who have sufficient cough function and no aspiration during VFSS. We suggest that if the patient is a proper candidate for NGT removal, direct oral feeding training with an NGT inserted could be a useful therapeutic strategy during the transitional period from long-term NGT feeding to successful oral feeding.

Asunto(s)

Trastornos de Deglución , Deglución , Nutrición Enteral , Intubación Gastrointestinal , Humanos , Trastornos de Deglución/terapia , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Femenino , Masculino , Anciano , Nutrición Enteral/métodos , Persona de Mediana Edad , Deglución/fisiología , Anciano de 80 o más Años , Dieta , Fluoroscopía , Factores de Tiempo

RESUMEN

Cerebral palsy (CP) results in non-progressive damage to the central nervous system, leading to functional disorders of the gastrointestinal tract and requiring enteral nutrition via gastrostomy in some patients. The aim of the study was to assess the impact of enteral nutrition on intestinal inflammation expressed by stool calprotectin and intestinal permeability determined by fecal zonulin and IFABP, and to determine whether CP affects these parameters. The study group consisted of 30 children with CP, fed enterally (Cerebral Palsy Enteral Nutrition-CPEN), and two reference groups: 24 children with CP, fed orally with a standard diet (CPC-Cerebral Palsy Controls) and 24 healthy children (HC-healthy controls). The differences between these groups and between the combined CP groups (CPG and CPEN + CPC) and HC were analyzed. Fecal zonulin, calprotectin, and intestinal fatty acid-binding protein 2 (IFABP2) levels were determined by ELISA. The concentrations of fecal calprotectin and zonulin were significantly higher in the CPEN group than in the CPC group (p = 0.012, p = 0.025). When comparing the CPG (n = 53) with the HC group (n = 24), statistically significant differences were observed for calprotectin (p = 0.000018, higher in the CPG) and IFABP (p = 0.021, higher in HC). Enteral nutrition was associated in our cohort with increased fecal calprotectin and zonulin. Children with cerebral palsy presented with increased fecal calprotectin but not increased intestinal permeability expressed by stool zonulin.

Asunto(s)

Biomarcadores , Parálisis Cerebral , Toxina del Cólera , Nutrición Enteral , Heces , Haptoglobinas , Funcion de la Barrera Intestinal , Complejo de Antígeno L1 de Leucocito , Precursores de Proteínas , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios de Casos y Controles , Parálisis Cerebral/metabolismo , Nutrición Enteral/métodos , Proteínas de Unión a Ácidos Grasos/metabolismo , Heces/química , Haptoglobinas/metabolismo , Inflamación , Mucosa Intestinal/metabolismo , Intestinos , Complejo de Antígeno L1 de Leucocito/análisis , Complejo de Antígeno L1 de Leucocito/metabolismo , Precursores de Proteínas/metabolismo

RESUMEN

BACKGROUND/AIMS:  This retrospective single-center study aimed to assess the safety of early feeding in patients who met certain criteria following peroral endoscopic myotomy (POEM). MATERIALS AND METHODS:  Data from 100 patients who underwent POEM at our center between January and December 2022 were collected. Early feeding was defined as the introduction of clear liquid foods at 4 hours post procedure. At 4 and 24 hours, the pain was rated using the visual analog scale (VAS) in all patients. Patients without intraoperative complications (pneumoperitoneum requiring needle drainage, severe arterial bleeding requiring the use of hemostatic forceps, severe mucosal injury) and severe pain (VAS score > 6) and nausea-vomiting at the fourth postoperative hour were given the early feeding approach. In patients who did not meet these requirements, enteral feeding was initiated after 24 hours (late feeding). RESULTS:  Among the 100 patients, 50 patients were categorized early feeding. No patients had a control esophagogram. In the early and late enteral feeding groups, VAS scores were 4 (0-6) and 6 (1-8) (P< 001) at 4 hours and 1 (0-3) and 1 (0-6) (P = .043) at 24 hours, respectively. No severe complications were developed after early feeding. The median hospital stay in the early feeding group was 1 (1-3) day. There was no emergency readmission in any of early feeding patients. CONCLUSION:  Our study showed early feeding following POEM can be begun in achalasia patients who do not have intraoperative complications, severe pain, or nausea/vomiting.

Asunto(s)

Nutrición Enteral , Acalasia del Esófago , Humanos , Acalasia del Esófago/cirugía , Femenino , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Adulto , Nutrición Enteral/métodos , Nutrición Enteral/efectos adversos , Centros de Atención Terciaria , Miotomía/métodos , Miotomía/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Anciano , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/métodos , Complicaciones Posoperatorias/etiología , Dimensión del Dolor , Cuidados Posoperatorios/métodos , Adulto Joven

RESUMEN

The "Guidelines for parenteral nutrition in preterm infants: the American Society for parenteral and enteral nutrition" were developed by the American Society for Parenteral and Enteral Nutrition and published in the Journal of Parenteral and Enteral Nutrition in September 2023. The guidelines provide recommendations on 12 key clinical questions regarding parenteral nutrition (PN) for preterm infants. In comparison to similar guidelines, this set offers more detailed perspectives on PN for preterm infants. It presents evidence-based recommendations for the commencement time, nutrient dosage, and composition of PN, considering primary outcomes such as growth and development, as well as secondary outcomes like sepsis, retinopathy of prematurity, parenteral nutrition-related liver disease, and jaundice. This article aims to interpret the guidelines to provide a reference for colleagues in the field.

Asunto(s)

Nutrición Enteral , Recien Nacido Prematuro , Nutrición Parenteral , Guías de Práctica Clínica como Asunto , Humanos , Nutrición Parenteral/normas , Nutrición Parenteral/métodos , Recién Nacido , Nutrición Enteral/normas , Nutrición Enteral/métodos , Sociedades Médicas

RESUMEN

BACKGROUND: Early nutrition after acute ischemic stroke is crucial. We explored early enteral nutrition for stroke patients and evaluated changes in blood indicators as a predictor of stroke prognosis. METHODS: All hospitalized stroke patients receiving enteral nutrition were included in the study. We retrospectively collected the protein, energy, fat, and carbohydrate values for 7 days after admission. Serum albumin, total protein, and hemoglobin values were reviewed at admission and at one week. The main outcome indicators were the Modified Rankin Score, Barthel Index, and Quality of Life at 3 months. RESULTS: A total of 354 patients (mean age, 70.7 years; 59.0% male) were included. The change in serum albumin at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.001), the Barthel Index (p = 0.004), and the modified Rankin Score (p = 0.029). The change in total protein at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.002), the Barthel Index (p = 0.001), and the modified Rankin score (p = 0.011). The change in hemoglobin values at day 7 relative to at admission was positively correlated with the Barthel Index (p = 0.037 but not with the Quality of Life score (p = 0.237) or the modified Rankin score (p = 0.730). CONCLUSIONS: Improved nutrition-related blood indicators one week after admission were independently associated with good stroke outcomes. Nutritional support for acute ischemic stroke patients during the early hospitalization stage appears to be advisable. TRIAL REGISTRATION: This review was a retrospective cohort study. The study was retrospectively registered in the Chinese Clinical Trial Registry (No: ChiCTR2300077228). Registration date: 1/11/2023.

Asunto(s)

Nutrición Enteral , Accidente Cerebrovascular Isquémico , Humanos , Masculino , Femenino , Nutrición Enteral/métodos , Estudios Retrospectivos , Anciano , Accidente Cerebrovascular Isquémico/sangre , Accidente Cerebrovascular Isquémico/terapia , Persona de Mediana Edad , Estado Nutricional/fisiología , Resultado del Tratamiento , Anciano de 80 o más Años , Biomarcadores/sangre , Calidad de Vida , Estudios de Cohortes , Hemoglobinas/análisis , Hemoglobinas/metabolismo , Albúmina Sérica/análisis , Albúmina Sérica/metabolismo

RESUMEN

It is important to identify true refractoriness of seizures, before escalation of anti-seizure medications, to avoid side effects of medications. Bioavailability of medications changes with the formulations used and changes significantly with the route of administration. Both of these were significantly impacted in a lady who was being fed via percutaneous endoscopic gastrostomy (PEG) feeds and deemed refractory to medications. After altering the formulations and the method, she became seizure-free.

Asunto(s)

Nutrición Enteral , Convulsiones , Humanos , Femenino , Nutrición Enteral/efectos adversos , Nutrición Enteral/métodos , Convulsiones/etiología , Gastrostomía/efectos adversos , Gastrostomía/métodos , Anticonvulsivantes/administración & dosificación , Adulto

RESUMEN

Over the last decades, surgical complication rates have fallen drastically. With the introduction of new surgical techniques coupled with specific evidence-based perioperative care protocols, patients today run half the risk of complications compared with traditional care. Many patients who in previous years needed weeks of hospital care now recover and can leave in days. These remarkable improvements are achieved by using nutritional stress-reducing care elements for the surgical patient that reduce metabolic stress and allow for the return of gut function. This new approach to nutritional care and how it is delivered as an integral part of enhancing recovery after surgery are outlined in this review. We also summarize the new and increased understanding of the effects of the routes of delivering nutrition and the role of the gut, as well as the current recommendations for artificial nutritional support.

Asunto(s)

Apoyo Nutricional , Atención Perioperativa , Humanos , Atención Perioperativa/métodos , Apoyo Nutricional/métodos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Nutrición Enteral/métodos , Estado Nutricional

RESUMEN

BACKGROUND: Patients in the intensive care unit (ICU) are highly susceptible to malnutrition, and while enteral nutrition via nasogastric tube is the preferred method, there is a risk of inadvertent reflux and aspiration. Therefore, clinicians have turned to nasointestinal tubes (NET) for enteral nutrition as an alternative option. But the precise localization of NET presents an ongoing challenge. We proposed an innovative approach to provide a valuable reference for clinicians involved in NET placement. METHOD: Data were obtained retrospectively from the medical records of adult patients with a high risk of aspiration or gastric feeding intolerance who had a NET placed in the ICU of Zhejiang Provincial People's Hospital between October 1, 2017, and October 1, 2023. The collected data were subjected to statistical analysis using SPSS and R software. RESULT: There were 494 patients who met the inclusion and exclusion criteria. The first-pass success rate was 81.4% (n = 402). The success of a patient's initial NET placement was found to be associated with Angle SPC and Distance CP, as determined by univariate analysis (25.6 ± 16.7° vs. 41.9 ± 18.0°, P < 0.001; 40.0 ± 26.2 mm vs. 62.0 ± 31.8 mm, P < 0.001, respectively). By conducting a multivariate regression analysis, we identified a significant association between pyloric types and the success rate of placing NET (OR 29.559, 95%CI 14.084-62.038, P < 0.001). CONCLUSION: Angle SPC, Distance CP, and the type of pylorus are independently associated with successful initial placement of NET. Besides, patients with the outside type of pylorus (OP-type) exhibit a higher rate of initial placement success.

Asunto(s)

Nutrición Enteral , Intubación Gastrointestinal , Humanos , Estudios Retrospectivos , Femenino , Masculino , Intubación Gastrointestinal/métodos , Nutrición Enteral/métodos , Persona de Mediana Edad , Anciano , Análisis Multivariante , Estómago/diagnóstico por imagen , Adulto , Unidades de Cuidados Intensivos