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Background: Enteral feeding uses feeding tubes for liquid food administration. Enteral feeding maintains gastrointestinal function but has complications like aspiration, diarrhea, and constipation. To avoid complications, nurses in intensive care units must have proper knowledge, attitude, and practice towards enteral feeding. Method: A systematic review was conducted. The search was restricted to January 2000 to April 2024, encompassing scientific journals accessible via the following online databases: PubMed (including Medline), Cochrane Library, Scopus, Web of Science, and Embase. Google Scholar was searched comprehensively to include all relevant studies. The search strategy employed the following keywords and medical subject headings: [knowledge OR attitude] AND [enteral feeding OR enteral nutrition] AND nurs*. Only cross-sectional studies were included in this systematic review. Two authors independently conducted the selection of eligible studies, data extraction, and risk of bias assessment. Due to the discrepancies in methodologies and research goals among the investigated studies, a narrative synthesis was conducted. Results: In total, there were 3187 articles found in the initial search across five online electronic databases. Finally, a thorough review was conducted, incorporating 22 studies. Based on the studies analyzed in this systematic review, nurses showed a positive attitude toward enteral feeding; there was a necessity to enhance their knowledge and practice. Continuous education combined with interdisciplinary collaboration can significantly improve nurses' knowledge and practice of enteral feeding. Conclusion: Many studies highlight the necessity of enhancing the knowledge and practice of nurses in this area. Implementing educational interventions has positively impacted nurses' knowledge and performance. [ABSTRACT FROM AUTHOR]

Background: Given that Telemedicine are widespread in China, and we have developed home enteral nutrition service with telemedicine (HENST) to satisfy HEN requirement of patients. However, only little is known about patient's experience of HENST model. The objective of this interview study was to explore patient's experiences and improvement direction of the HENST model. Methods: The revisit station of HEN patients between 2018 and 2022 were counted. And epidemiological characteristics of HENST patients in 2022 were collected. Meanwhile, the structured survey was conducted to collect experiences about HENST model from part HEN patients in 2022. Results: The revisit rate of HEN patients increased from 25.8% to 35.8%, and the major revisit approach changed from face-to-face clinic visits to HENST. Overall, 1437 HENST patients with 3710 visit records in 2022. Median age was 58.0 years, and most patients were from Chengdu (61.3%). For interview subjects, distance and expense from home to hospital for HENST patients were more than those for face-to-face clinic visit patients, illustrating that HENST can save time and expenses. The patient satisfaction rate for HENST was 98.7%, and viewpoints of HENST improve the visit experience have been deemed by majority HENST patients (81.8%). For face-to-face clinic visit patients, prefer to face-to-face communication was the main reason why not choose HENST. Conclusions: HENST is a economic beneficial visit model, with high satisfaction. We should optimize and promote existing video call function of this platform to meet the demands of face-to-face communication. Trial registration: The study was registered in the Chinese Clinical Trial Registry (clinical registration number: ChiCTR2100053762, registration date: 2021–11-29). [ABSTRACT FROM AUTHOR]

Évaluer les stratégies d'apports hydriques chez les prématurés de moins de 32 semaines en comparaison aux recommandations d'ESPGHAN de 2018. Étude rétrospective, descriptive allant du 1er juin 2022 au 31 juin 2023, portant sur 77 prématurés de moins de 32 semaines d'aménorrhées hospitalisés pendant au moins 15 jours. Les apports hydriques par voie entérale et parentérale étaient conformes aux recommandations d'ESPGHAN chez les moins de 1500 g et supérieurs chez les plus de 1500 g. Cependant, 52 (67 %) prématurés avaient une perte de poids non optimale dont 39 (51 %) avaient perdu plus de 10 % entre J2–J3 et 13 (17 %) ont perdu moins de 7 %. L'étude de la perte de poids en excluant l'alimentation entérale des apports hydriques avait noté que 30/52 prématurés avaient des apports hydriques inférieurs aux recommandations. Parmi eux, 23 prématurés qui avaient perdu plus de 10 % étaient caractérisés par une diurèse abondante, 7 cas de dysnatrémies et 7 prématurés ayant perdu moins de 7 % avaient une diurèse normale. En outre, 22/52 prématurés avaient des apports hydriques conformes aux recommandations d'ESPGHAN dont 16 avaient perdu plus de 10 % présentaient une diurèse abondante, 9 cas de dysnatrémies, 5 cas de macrosomies et 6 prématurés avec une perte de poids insuffisante présentaient une diurèse abondante, 2 cas RCIU. Les apports hydriques étaient inférieurs aux recommandations d'ESPGHAN chez plus de 50 % des prématurés avec une perte de poids non optimale en excluant l'alimentation entérale. Ces apports hydriques doivent être individualisés à chaque prématuré en fonction de la diurèse et de l'immaturité digestive. Cette perte de poids associait la macrosomie et le RCIU d'où l'étude de la composition corporelle de ses prématurés s'avère importante. Evaluate fluid intake strategies in premature infants under 32 weeks in comparison with the 2018 ESPGHAN recommendations. Retrospective, descriptive study from June 1st, 2022 to June 31st, 2023, involving 77 premature infants less than 32 weeks of amenorrhea hospitalized for at least 15 days. Fluid intake (enteral and parenteral) was consistent with recommendations in those under 1500 g and higher in those over 1500 g. However, 52 (67 %) premature babies had non-optimal weight loss, of which 39 (51 %) had lost more than 10 % between D2–D3 and 13 (17 %) lost less than 7 %. The study of weight loss by excluding enteral feeding from fluid intake noted that 30/52 premature infants had fluid intakes lower than recommendations. Among them, 23 premature infants who had lost more than 10 % were characterized by abundant diuresis, 7 cases of dysnatremia and 7 premature infants who had lost less than 7 % had normal diuresis. In addition, 22/52 premature infants had fluid intake consistent with ESPGHAN recommendations, 16 of whom had lost more than 10 %, had abundant diuresis, 9 cases of dysnatraemia, 5 cases of macrosomia and 6 premature infants with insufficient weight loss had abundant diuresis, 2 RCIU cases. Fluid intake was lower than ESPGHAN recommendations in more than 50 % of premature babies with non-optimal weight loss excluding enteral feeding. Its intake must be individualized for each premature baby according to diuresis and digestive immaturity. This weight loss associated macrosomia and IUGR, hence the study of the body composition of premature babies is important. [ABSTRACT FROM AUTHOR]

The management of sedation in critically ill adults poses a unique challenge to clinicians. Dexmedetomidine, an α2 agonist, has a unique mechanism and favorable pharmacokinetics, making it an attractive intravenous option for sedation and delirium in the intensive care unit. However, patients may be at risk for withdrawal with prolonged use, adding to the complexity of sedation and agitation management in this patient population. Enteral α2 agents have the benefit of cost savings and ease of administration, thus playing a role in the ability to decrease intravenous sedative use and prevent dexmedetomidine withdrawal. Clonidine and guanfacine are the two most common enteral α2 agents utilized for this purpose, however, there is a paucity of evidence regarding the comparative benefit between the two agents. The decision to use one vs the other agent should be determined based on their differing pharmacology, pharmacokinetics, and side effect profile. The most effective dosing strategy for these agents is also unknown. Ultimately, more robust literature is required to determine enteral α2 agonists place in therapy. This narrative review evaluates the currently available literature on the use of α2 agonists in critically ill adults with an emphasis on sedation, delirium, and withdrawal. [ABSTRACT FROM AUTHOR]

• A tool to help decision-making for challenging adult's hyperglycemia management. • The document adapts recommendations from four well developed and updated guidelines. • 75 recommendations were endorsed with high concordance among the selected guideline. Over the past decade, diabetes mellitus (DM) has emerged as a growing epidemic, with a direct link to an increased risk of hospitalization and a strong effect of glycemic control on clinical outcomes. The aim of this document was to critically appraise and adapt existing clinical practice guidelines (CPGs) to provide specific recommendations for the management of hyperglycemia in hospitalized adults with and without previously known DM, in an attempt to provide a practical tool to reduce the risk of major in-hospital complications. The first step of the adaptation process was to identify unsolved clinical questions (PICOs) in hospitalized persons with hyperglycemia. This was followed by a critical appraisal of updated existing CPGs and the selection of recommendations that were most applicable to specific clinical situations. From the four updated high-quality evidence-based CPGs, 75 recommendations were selected, focusing on five common clinical scenarios in real-world practice: 1) glycemic targets; 2) persons with comorbidities; 3) elderly adults with low consciousness or dementia with irregular feeding or parenteral/enteral nutrition; 4) special hyperglycemic scenarios (stress hyperglycemia, corticosteroid treatment, fasting); and 5) glucose-lowering therapy at discharge. Of the 75 selected recommendations (59 strong and 16 weak), 37 were based on high-quality evidence, 8 on moderate-quality evidence, and 17 on low-quality evidence, while 13 were based on consensus (best practice statements). The recommendations apply to adults who are hospitalized or discharged from the hospital. Using a systematic methodology, this guideline provides an updated and ease-to-use tool for the management of hospitalized adults with hyperglycemia. [ABSTRACT FROM AUTHOR]

Background: Neonatal appendicitis (NA) is a rare condition with an estimated incidence of 0.04% to 0.2%. It is more prevalent in male preterm infants, with a mortality rate of 20% to 25%. It is usually misdiagnosed as neonatal necrotizing enterocolitis (NEC) owing to its diverse diagnostic challenges. Poor perfusion, hypoxia, anemia, or any other condition that impairs intestinal blood supply is a risk factor for bowel injury, which could explain the physiopathology of NA. Clinical Findings: We describe an interesting case of a preterm infant with recurrent episodes of abdominal distension and persistent anemia who was finally diagnosed with NA. Primary Diagnosis: The patient was treated with exploratory laparotomy and appendicectomy, with further symptom resolution. The diagnosis was confirmed by pathological examination. Interventions: Surgery for acute abdomen secondary to perforated appendicitis. Outcomes: Improved recurrent abdominal distension and persistent anemia and achieved full enteral nutrition. Patients with other diseases such as Hirschsprung's disease were ruled out. Practice Recommendations: This case demonstrates that identifying the early signs and symptoms of NA requires a high index of suspicion. Anemia may play a significant role in the etiology of intestinal injury, increasing the risk of NA and NEC. Further studies are needed to explore the association between anemia and intestinal injury and its implications for neurodevelopment. [ABSTRACT FROM AUTHOR]

Objective The transition from the neonatal intensive care unit (NICU) to the home is complex and multifaceted for families and infants, particularly those with ongoing medical needs. Our hospital utilizes a remote monitoring program called Growing @ Home (G@H) to support discharge from the NICU with continued nasogastric tube (NGT) feeds. We aim to describe the experience of the transition from NICU to home for families enrolled in G@H. Study Design Using a semistructured interviewing technique, parents of infants discharged on G@H were interviewed at NICU discharge, at 1 month, and at 6 months after NICU discharge. Interviews were recorded and transcribed into data analysis software. Conventional content analysis was used to analyze qualitative data. Codes were assigned to describe key elements of the interviews and used to identify major themes. Results Parents (n = 17) identified three major themes when discussing the effect of G@H on the transition to home. The program provided a means of escape from the NICU, allowing families to stop living split lives between their homes and the NICU. It acted as a middle ground between the restrictive yet supportive NICU environment, and the normal yet isolated home environment. G@H served as a safety net for families, providing a continued connection to the NICU for their still-fragile infants. Conclusion G@H utilizes telehealth to positively support the complex transition from NICU to home for families and infants discharged with NGT feeds. Key Points G@H program supported parents in their transition from NICU to home. G@H program provided a means of escape from the NICU. G@H program was a middle ground between the NICU and home. G@H program created a safety net after discharge. Follow-up with a consistent provider was essential to a positive parent experience. [ABSTRACT FROM AUTHOR]

Background: A systematic appraisal of the comparative efficacy and safety profiles of naso-intestinal tube versus gastric tube feeding in the context of enteral nutrition for mechanically ventilated (MV) patients is imperative. Such an evaluation is essential to inform clinical practice, ensuring that the chosen method of nutritional support is both optimal and safe for this patient population. Methods: We executed an exhaustive search across PubMed et al. databases to identify randomized controlled trials (RCTs) that scrutinize the role of naso-intestinal and gastric tubes for mechanically ventilated (MV) patients up to May 30, 2024. The process of study selection, quality assessment, and data extraction was conducted independently by two researchers. RevMan 5.3 software was used for meta-analysis. Results: Our meta-analysis included 8 RCTs, published between 1992 and 2018, encompassing a total of 676 MV patients. The results indicated that naso-intestinal tube feeding, compared to gastric tube feeding, was associated with a significant reduction in the incidence of ventilator-associated pneumonia (VAP) [Risk Ratio (RR) = 0.69, 95% confidence interval (CI) (0.52, 0.92)] and gastric retention (RR = 0.11, 95% CI (0.04, 0.28)). No statistically significant differences were observed in the incidence of aspiration (RR = 0.93, 95% CI (0.35, 2.50)) vomiting (RR = 0.70, 95% CI (0.23, 2.08)), abdominal distension (RR = 0.87, 95% CI (0.29, 2.63)), or diarrhea (RR = 1.10, 95% CI (0.77, 1.55)). Conclusions: The current evidence indicates that naso-intestinal tube feeding is efficacious in lowering the incidence of VAP and gastric retention among MV patients, without a corresponding escalation in the risk of adverse events, including aspiration, vomiting, abdominal distension, and diarrhea. These insights significantly augment the existing corpus of knowledge pertaining to the optimization of enteral nutrition strategies for patients on mechanical ventilation. [ABSTRACT FROM AUTHOR]

Enteral nutrition (EN) formulas are necessary for critically ill patients to meet their metabolic requirements. Polyamines (putrescine, spermidine, and spermine) are crucial dietary components, with spermidine being particularly interesting due to its multiple proposed benefits. The requirements for and intake of polyamines have yet to be investigated in adult patients hospitalised in intensive care units (ICUs) who are exclusively fed via commercial EN formulas. The aim of this study was to determine the polyamine content and other biogenic amines of EN formulas and the total intake and gastric residual volume (GRV) in adult ICU patients during their first seven days of hospitalisation. The amines were analysed in 16 EN formulas using high-performance liquid chromatography (HPLC). The clinical data of eight patients of both sexes aged 47 to 77 admitted to the ICU were analysed. Differences existed among the analysed EN formulas. The N-acetyl putrescine content was higher than that of the remaining amines. The daily intake of polyamines in the ICU was less than 100 μmol (the dietary intake is above 400 μmol). An inverse correlation existed between total daily polyamine intake and daily GRV, without effects from other biogenic amines being analysed. Polyamine intake in critically ill patients receiving EN is low and could impact these patients' feeding tolerance. These findings underscore the need for further research to explore the clinical implications of increasing the polyamine content of EN formulas. [ABSTRACT FROM AUTHOR]

Background/Objectives: Early-onset sepsis in neonates is a potentially catastrophic condition that demands prompt management. However, laboratory diagnosis via cerebral spinal fluid and blood tests is often inconclusive, so diagnosis on the basis of clinical symptoms and risk factors is frequently required, and the majority of neonates treated with antibiotics for presumed early-onset sepsis (PEOS) do not have culture-proven sepsis. The management of such PEOS is mainly achieved via antibiotic therapy, which itself has adverse effects, creating a dilemma for clinicians in optimising healthcare. This study aimed to assess the impact of PEOS management on the common neonatal concerns of feeding tolerance, hyperbilirubinaemia, weight gain, and length of stay (LoS) in moderate to late preterm infants. Methods: A single-site, matched-cohort, retrospective study was performed on infants born between 32+3 and 36+6 weeks (2016 to 2019) admitted to the Neonatal Unit. PEOS infants on antibiotics (PEOS) were strictly matched by gestational age (±1 day) and birthweight (±5%) against a non-PEOS reference group (NPEOS). The key outcomes included the following: enteral feeding commencement and achievement; feeding intolerance (FI); phototherapy commencement and duration; antibiotic therapy duration; maximum bilirubin (MaxBili); LoS; and net postbirth weight gain. Results: There were no cases of culture-proven early-onset sepsis. PEOS (n = 185): NPEOS (n = 185) via multivariable analysis showed delayed enteral feed commencement (adjusted Odds Ratio [aOR]: 2.75; 95% confidence interval [CI]: 2.32, 3.27); there was no difference in FI, delayed onset of peak jaundice (aOR: 1.24; 95%CI: 1.12, 1.37), increased duration of phototherapy (aOR: 1.24; 95%CI: 1.10, 1.41), and increased LoS (aOR: 1.31; 95%CI; 1.02, 1.67). A univariate analysis also showed the following results (PEOS: NPEOS): no significant difference in MaxBili and delayed full enteral feed achievement (p = 0.010). Univariant or multivariable analysis showed no difference in irradiance levels. However, for NPEOS infants undergoing 0 or 1 phototherapy light treatment, there was an increased irradiance for PEOS (<0.001, 0.037, respectively). Conclusions: In moderate to late preterm infants, while PEOS diagnosis and management resolve the negative health impacts of potential sepsis, they are associated with negative healthcare outcomes on feeding, jaundice, and hospital length of stay. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) in pediatric populations, there is a paucity of data on the indications and outcomes of this procedure in Switzerland. This manuscript presents our experience with PEG indication, outcomes, and related complications in children. Methods: This single-center retrospective study included patients < 18 years old who underwent PEG placement between 2007 and 2016. We retrieved demographics, PEG indications, associated comorbidities, pre-placement workup, growth parameters up to 12 months, and associated complications. Results: Eighty-one patients were included, with a median age of 7 years. Common indications included inadequate caloric intake (85%), failure to thrive, and feeding difficulties. Neurological conditions (46%) were the most commonly associated comorbidity. Thirty-six patients (44%) underwent a pH study before PEG placement. There were significant increases in z-scores for weight (p < 0.002) and body mass index (p < 0.001) 12 months after PEG placement. Minor complications were relatively frequent (n = 55, 68%), mainly granulation tissue or local erythema. Two patients had major complications. Conclusion: PEG is a safe technique for providing long-term enteral nutrition in children, with neurological disease being the most common clinical indication. Our experience demonstrated significant weight gain in children after one year of PEG, with frequent but well-controlled complications. [ABSTRACT FROM AUTHOR]

Background: Literature regarding the advantages of HFNC in infants for ensuring oxygen supply after non-cardiac surgery is insufficient. The purpose of our study is to compare COT vs. HFNC on postoperative outcomes in infants undergoing non-cardiac surgery. We hypothesize that prophylactic use of HFNC after non-cardiac surgery in infants would reduce the incidence of post-anesthesia hypoxemia and could also be adapted as first-line oxygen therapy after non-cardiac surgery. Methods: This is a superior, single-blind, randomized controlled study. A total of 394 infants undergoing general anesthesia will be randomly assigned to accept COT or HFNC in a 1:1 ratio. The primary outcome is the rate of desaturation post-extubation. Secondary outcomes include the rate of mild upper airway obstruction, the rate of severe respiratory depression, the rate of transfer to PICU, duration of oxygen therapy, length of PACU stay, the time to reach full enteral feeding, and postoperative adverse events, including nasal injury, agitation, vomiting, and unplanned secondary surgery related to the initial surgery. Discussion: This is the first randomized controlled trial to explore the advantages of HFNC in infants to ensure oxygen supply after non-cardiac surgery. If favorable evidence is obtained, HFNC could be adopted as first-line oxygen therapy for infants following non-cardiac surgery. Trial registration: The trial was registered at https://www.chictr.org.cn (Registration number: ChiCTR2400081600, Date: March 6, 2024). [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to explore the risk factors associated with intensive care unit- acquired weakness (ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition (EEN) and the role of biomarkers in managing ICU-AW. METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-Aw group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition (PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW. RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation (MV), body mass index (BMI), blood urea nitrogen (BUN), and creatinine (Cr) levels (P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed (log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin (PAB)/ C-reactive protein (CRP) ratio had the highest diagnostic accuracy (area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892-0.946), surpassing the mean Cr/BUN ratio (AUC 0.740, 95% CI 0.663-0.819) and mean transferrin levels (AUC 0.653, 95% CI 0.574-0.733). CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition. [ABSTRACT FROM AUTHOR]

The article "Breaking barriers: achieving equitable access to postoperative critical care" published in Anaesthesia discusses the impact of postoperative critical care on patient outcomes following major surgery. The study led by Campbell et al. highlights the challenges in allocating and utilizing critical care beds effectively. While critical care admission may offer benefits such as increased monitoring and access to specialized staff, it also poses risks such as infections and psychological stress. The study emphasizes the need for evidence-based guidelines to ensure equitable access to critical care and optimize patient outcomes, especially for high-risk surgical patients. [Extracted from the article]

The association of enteral micronutrient supplementation and the neurodevelopmental outcomes of preterm or low birth weight (LBW) infants is controversial. This research was prospectively registered (CRD42023454034). We searched MEDLINE, Embase, PsycInfo, ClinicalTrials. gov, and the Cochrane Library for randomised clinical trials (RCTs) or quasi‐RCTs comparing any enteral micronutrients supplementation with placebo or no supplementation in preterm or LBW infants. The primary outcome was neurodevelopmental impairment (NDI), with secondary outcomes involving various neurodevelopmental tests and disabilities. There was no evidence of an association between enteral micronutrients supplementation and the risk of NDI (RR, 1.03; 95% CI, 0.93–1.14; moderate certainty evidence). There was no evidence that the supplemented groups enhanced cognitive (MD, 0.65; 95% CI, −0.37 to 1.67; low certainty evidence), language (SMD, −0.01; 95% CI, −0.11 to 0.09; moderate certainty evidence), or motor scores (SMD, 0.04; 95% CI, −0.06 to 0.15; very low certainty evidence) or IQ (SMD, −0.20; 95% CI, −0.53 to 0.13; very low certainty evidence). Subgroup analysis showed that multiple micronutrients supplementation improved expressive language score (MD, 1.42; 95% CI, 0.39–2.45), and zinc supplementation enhanced fine motor score (SMD, 1.70; 95% CI, 0.98–2.43). The overall heterogeneity was low. This study demonstrates that enteral micronutrient supplementation is associated with little or no benefits in neurodevelopmental outcomes for preterm or LBW infants. Well‐designed RCTs are needed to further ascertain these associations. Key messages: There is little or no evidence that enteral micronutrient supplementation during infancy is associated with a decreased risk of neurodevelopmental impairment in preterm or low birth weight infants.Multiple micronutrient supplementation may improve expressive language score, and zinc supplementation may enhance gross motor and fine motor scores.Future well‐designed randomised clinical trials with more participants and longer follow‐up are needed to further ascertain these associations. [ABSTRACT FROM AUTHOR]

Establishing healthy feeding habits during infancy is crucial for optimal growth. However, certain parental feeding and cultural practices might hinder the development of children's healthy eating behaviours. This research explored responsive feeding practices among migrant mothers in Australia. Semi‐structured telephone interviews were conducted in their native language with 20 Arabic and 20 Mongolian‐speaking migrant mothers with children under 2 years old or currently pregnant. Thematic analysis was conducted using the framework method. Both cultural groups followed a variety of feeding practices, including on demand responsive feeding or structured schedules. Arabic‐speaking mothers tended to demonstrate responsive feeding practices more frequently than Mongolian‐speaking mothers, except for those using formula feeding, who consistently followed a fixed feeding routine. When introducing solid foods, mothers from both groups often overlooked their babies' hunger and satiety cues, frequently pressuring their children to finish their entire plate. One cited reason for this was the challenge parents faced in identifying such cues. Arabic‐speaking mothers often supplemented with formula top‐ups after introducing solid foods, due to the belief that breast milk or solid foods alone might not sufficiently nourish their infants. Additionally, some Arabic‐speaking mothers used food‐based rewards to encourage eating. Mongolian mothers expressed a cultural preference for chubby babies, a potential reason why they may have been inclined to pressure‐feed their children. Moreover, both groups reported using digital devices to distract their children during meals. This study highlights the necessity of tailoring future resources and services related to responsive feeding practices to accommodate diverse literacy levels and cultural backgrounds. Key messages: Arabic‐speaking mothers generally exhibited responsive feeding practices more often than Mongolian‐speaking mothers, except for those employing formula feeding who consistently adhered to a set feeding schedule.Both Arabic and Mongolian‐speaking mothers reported difficulty in identifying their babies' hunger and satiety cues, resulting in instances where they felt compelled to pressure their children to eat.Future resources and services should be co‐designed with parents to accommodate diverse literacy levels and cultural backgrounds.Future resources should also prioritise guiding mothers to identify hunger and satiety cues when feeding their infants, as well as addressing misconceptions about food, health, and body image. This includes challenging the notion that chubby babies are inherently healthier. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aims of this multi-center study were to describe the characteristics of children receiving long-term home mechanical ventilation (HMV) in İstanbul and to compare the patients receiving non-invasive and invasive ventilation. MATERIAL AND METHODS: This cross-sectional multicenter study included all children receiving long-term HMV followed by admission to six tertiary hospitals. The data were collected between May 2020 and May 2021. Demographic data and data regarding HMV were collected from the patient charts. RESULTS: The study included 416 participants. The most common diagnoses were neuromuscular (35.1%) and neurological diseases (25.7%). Among the patients, 49.5% (n = 206) received non-invasive ventilation (NIV), whereas 50.5% (n = 210) received invasive ventilation. The median age at initiation was significantly younger in the invasive ventilation group than in the NIV group (10 vs. 41 months, P < 0.001). Most subjects in the NIV group (81.1%) received ventilation support only during sleep, whereas most subjects in the invasive ventilation group (55.7%) received continuous ventilator support (P < 0.001). In addition to ventilation support, 41.9% of the subjects in the invasive ventilation group and 28.6% in the NIV group received oxygen supplementation (P = 0.002). Within the last year, 59.1% (n = 246) of the subjects were hospitalized. The risk factors for hospitalization were invasive ventilation, continuous ventilatory support, oxygen supplementation, tube feeding, and swallowing dysfunction (P = 0.002, 0.009, <0.001, <0.001 and <0.001 respectively). CONCLUSION: Despite the increasing use of NIV in most studies, half of the study population received invasive ventilation. Patients receiving invasive ventilation were more likely to require continuous ventilator support and oxygen supplementation and were at increased risk of hospitalization. [ABSTRACT FROM AUTHOR]

Introduction: Early postoperative reflux (PR) can compromise anastomotic healing after Ivor Lewis esophagectomy (ILE) and poses a risk for aspiration. Anastomotic insufficiency is the most threatening surgical complication. We present the protective method of pre-emptive active reflux drainage (PARD) with simultaneous enteral feeding. We report our experience with this new safety concept in esophageal surgery in a cohort of 43 patients. Materials and Methods: For PARD we use a double lumen open porous film drainage (dOFD). To create the dOFD, the gastric tube of a Trelumina probe (Freka®Trelumina, Fresenius) is coated with a double-layered open-pore drainage film (Suprasorb®CNP drainage film, Lohmann & Rauscher) over a length of 25 cm. The dOFD is endoscopically inserted into the tubular stomach intraoperatively after completion of the anastomosis. Continuous negative pressure is applied with an electronic pump (−125 mm Hg). The PR is continuously aspirated completely and the stomach and anastomotic region are decompressed. At the same time, nutrition is delivered via an integrated intestinal tube. Depending on the results of the endoscopic control after 5 days, PARD is either continued or terminated. Results: During the observation period (2017–2023), PARD was used in all patients (n = 43) with ILE. The healing rate under PARD was 100% and healing was observed in all anastomoses. No additional endoscopic procedures or surgical revisions of the anastomoses were required. The median duration of PARD was 8 days (range 4–21). We observed problems in the healing of the anastomosis in 20 of 43 patients (47%) for whom we defined endoscopic criteria for at-risk anastomosis. Conclusions: Our results suggest that PARD has a strong protective effect on anastomotic healing and may reduce the risk of anastomotic insufficiency. The integrated feeding tube of the dOFD allows early postoperative enteral feeding while simultaneously applying negative pressure. PARD appears to prevent the negative consequences of impaired anastomotic healing. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) encompasses diverse conditions such as congenital anomalies, glomerulonephritis, and hereditary nephropathies, necessitating individualized nutritional interventions. Early detection is pivotal due to the heightened risk of adverse outcomes, including compromised growth and increased healthcare costs. The nutritional assessment in pediatric CKD employs a comprehensive, multidisciplinary approach, considering disease-specific factors, growth metrics, and dietary habits. The prevalence of malnutrition, as identified through diverse tools and guidelines, underscores the necessity for regular and vigilant monitoring. Nutritional management strategies seek equilibrium in calorie intake, protein requirements, and electrolyte considerations. Maintaining a well-balanced nutritional intake is crucial for preventing systemic complications and preserving the remaining kidney function. The nuanced landscape of enteral nutrition, inclusive of gastrostomy placement, warrants consideration in scenarios requiring prolonged support, with an emphasis on minimizing risks for optimized outcomes. In conclusion, the ongoing challenge of managing nutrition in pediatric CKD necessitates continuous assessment and adaptation. This review underscores the significance of tailored dietary approaches, not only to foster growth and prevent complications but also to enhance the overall quality of life for children grappling with CKD. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the efficacy of a double-lumen biliary-enteric tube (DBET) for enteral nutrition (EN) in individuals with malignant obstructive jaundice (MOJ). Methods: A retrospective cohort study was conducted using data from a prospectively maintained single-center database, including patients with MOJ. In the intervention group, DBET placement was performed concurrently with percutaneous transhepatic cholangiodrainage and biliary stenting, followed by postoperative EN (DBET-EN). In the control group, deep vein catheterization was undertaken after endoscopic biliary stenting, and parenteral nutrition (PN) was provided. A multivariable generalized linear model was used to assess the association between DBET-EN and 6-month mortality. Results: A total of 74 patients were included in this study, comprising 28 patients in the intervention group (DBET-EN group) and 46 patients in the control group (PN group). Within the 6-month follow-up, 5 patients (17.9%) in the DBET-EN group and 20 (43.5%) in the PN group died. The multivariable generalized linear model demonstrated a significantly reduced 6-month mortality in the DBET-EN group compared to the PN group (adjusted odds ratio [OR]: 0.25, 95% CI: 0.08–0.81, P = 0.020). Secondary outcomes indicated that patients in the DBET-EN group had lower 9-month mortality rates and longer tube retention durations compared to the PN group (all adjusted P < 0.05). Postoperative liver function improved similarly in both groups. At 3, 6, and 9 months postoperatively, patient-generated subjective global assessment (PG-SGA) scores and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) scores were significantly higher in the DBET-EN group than in the PN group (P < 0.05). Conclusion: The implementation of DBET for EN in patients in the advanced stage of MOJ proved to be a minimally invasive and safe intervention. It significantly improved patients' nutritional status and quality of life while reducing mortality. [ABSTRACT FROM AUTHOR]

Data supporting the safety and clinical efficacy of early oral feeding (EOF) after total gastrectomy are limited. The aim of this prospective randomized controlled study was to explore the safety and clinical efficacy of two early enteral nutrition approaches for gastric cancer patients after radical total gastrectomy. The EOF group had faster postoperative recovery of intestinal function than the enteral tube feeding (ETF) group. The times to first flatus and first defecation were shorter in the EOF group (p < 0.05). In addition, the EOF protocol effectively avoided abdominal distension (p < 0.05). The hospitalization cost of the EOF group was lower than that of the ETF group (p < 0.05). Moreover, oral nutrition satisfied the physiological need for oral intake. People were more satisfied with EOF (p < 0.01). Furthermore, it is worth noting that compared with ETF, EOF did not increase the risk of anastomotic complications such as leakage and bleeding. Most obviously, EOF not only avoided the risk of complications during tube insertion, but also avoided the discomfort experience of nasal feeding tube. In summary, compared with ETF, EOF promotes early bowel recovery effectively without increasing the risk of postoperative complications. It is safe and comfortable for gastric cancer patients undergoing radical total gastrectomy. [ABSTRACT FROM AUTHOR]

Sotorasib is approved to be taken as 960 mg orally once daily (8 × 120‐mg tablets) for the treatment of KRAS G12C‐mutated nonsmall cell lung cancer. Dispersion of tablets in water could be an alternative method for patients who require a liquid formulation due to dysphagia and enteral administration. A clinical study was conducted to assess the pharmacokinetics of 960 mg of sotorasib administered as tablets and as tablets dispersed in water in healthy volunteers. Each subject received 960 mg of sotorasib by mouth, as tablets and as tablets dispersed in water on Days 1 and 4. Sotorasib median time to maximum observed plasma concentration was similar when administered as tablets and as tablets predispersed in water. The geometric least squares mean ratios (water dispersion/tablets) for area under the concentration‐time curve from time 0 extrapolated to infinity and maximum observed plasma concentration were 1.049 and 1.080, respectively. Sotorasib 960 mg was well tolerated. Administration of 960 mg of sotorasib as tablets predispersed in water achieved similar systemic exposures to that of sotorasib administered as oral tablets. In vitro evaluations were performed to assess the feasibility of administering sotorasib through an enteral feeding tube. Approximately 98% of sotorasib was recovered, with no new impurities, from enteral feeding tubes. Collectively, these results support that sotorasib can be administered by mouth and via enteral feeding tubes as tablets predispersed in water. [ABSTRACT FROM AUTHOR]

Background: Postoperative nutritional support in gastrointestinal cancer, including enteral nutrition (EN), parenteral nutrition (PN), and combined nutrition strategies, is vital for enhancing recovery and patient outcomes. Aims: We aimed to comprehensively evaluate the impact of postoperative EN, PN, and EN + PN in patients with gastrointestinal cancer. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wan Fang, and VIP were searched from conception until January 2, 2024. Randomized controlled trials (RCTs) that compared different postoperative nutritional support (EN, PN, or EN + PN) in patients with gastrointestinal cancer were included. The Cochrane Risk of Bias Assessment tool was used to assess the quality of the RCTs. Fixed- and random-effects models were chosen according to the heterogeneity of variables for the synthesis of results. Continuous and categorical variables were analyzed using the weighted mean difference or relative risk (RR) and 95% confidence interval (CI). Results: In this meta-analysis, 11 RCTs were included. The PN + EN group exhibited significantly improved postoperative recovery, nutritional function, and immune indicators than the PN and EN groups (p < 0.05). Additionally, a higher incidence of postoperative complications such as abdominal distension (RR: 2.53; 95% CI: 1.17-5.49), nausea/vomiting (RR: 2.01; 95% CI: 1.09-3.71), and diarrhea (RR: 3.17; 95% CI: 1.41-7.10) was observed in the EN group than in the PN + EN group. Conclusion: Combining supplemental PN with enteral support improves energy intake and prognosis in gastrointestinal cancer, though limited studies restrict publication bias evaluation. [ABSTRACT FROM AUTHOR]

Background: The oropharyngeal administration of colostrum (OAC) in neonates has several benefits. Purpose: To investigate the short-term outcomes of OAC in preterm neonates. Methods: We performed this 2-arm, double-blind, placebo-controlled randomized trial at a tertiary neonatal center in Iran in 2021-2023. The intervention and control arms received 0.2 mL of their mother's colostrum or distilled water via oropharyngeal administration every 6 hours for 3 days starting from birth until 72 hours of age. The main study outcomes were neonatal death, the incidence of necrotizing enterocolitis, sepsis, retinopathy of prematurity (ROP), length of hospital stay, and period to full enteral feeding. A regression analysis was used to adjust for possible confounders. Results: A total of 126 neonates (mean gestational age, 30.05 weeks) were randomized to the intervention and placebo groups (n=63 each) and had a mean±standard deviation weight of 1,247±193 g versus 1,156±215 g (P=0.013) and 1- and 5-min Apgar scores of 6.35 versus 5.38 (P=0.003) and 7.84 versus 7.13 (P=0.001), respectively. The mortality rate was 12.7% in the intervention group versus 14.3% in the placebo group (P=0.794). The necrotizing enterocolitis rate was significantly lower in the intervention versus placebo arm (11.1% vs. 28.6%, respectively, P=0.010), as was the clinically suspected sepsis rate (15.9% vs. 39.7%, respectively, P=0.004). The ROP and bronchopulmonary dysplasia rates did not differ significantly between groups after the adjustment for confounders. The mean length of hospital stay was shorter in the intervention group (26.1 days vs. 37.32 days, P=0.023). Moreover, the mean duration of antibiotic therapy and period to full feeding were significantly shorter in the intervention group. Conclusion: OAC could effectively decrease the incidence of complications in preterm infants and facilitate earlier patient discharge. [ABSTRACT FROM AUTHOR]

Purpose: Emerging research in the field of microbiology has indicated that host--microbiota interactions play a significant role in regulating health and disease. Whereas the gut microbiome has received the most attention, distinct microbiota in other organs (mouth, larynx, and trachea) may undergo microbial shifts that impact disease states. A comprehensive understanding of microbial mechanisms and their role in communication and swallowing deficits may have downstream diagnostic and therapeutic implications. Method: A literature review was completed to provide a broad overview of the microbiome, including differentiation of commensal versus pathogenic bacteria; cellular mechanisms by which bacteria interact with human cells; site-specific microbial compositional shifts in certain organs; and available reports of oral, laryngeal, and tracheal microbial dysbiosis in conditions that are associated with communication and swallowing deficits. Results/Conclusions: This review article is a valuable tutorial for clinicians, specifically introducing them to the concept of dysbiosis, with potential contributions to communication and swallowing deficits. Future research should delineate the role of specific pathogenic bacteria in disease pathogenesis to identify therapeutic targets. [ABSTRACT FROM AUTHOR]

Optimum nutrition leads to improved long-term neurodevelopmental outcomes in both preterm and term infants admitted to neonatal units (NNUs). This review delineates the phases of nutritional management from full parenteral nutrition, transitioning to enteral nutrition and on to full enteral feeds. It describes the essential components and provides practical tips in the management of nutrition in these infants. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal tube feeding is one of the most important and beneficial methods of nutrition in patients admitted to the intensive care unit. There is still no consensus on the best nutritional method that will lead to fewer complications. This study aimed to investigate the disadvantages of different methods of tube feeding in patients admitted to the adult intensive care unit. Methods: The present study is a review study conducted in 2022. Articles published in the English language databases including Web of Science, Scopus, Science Direct, and PubMed, between 2000 and 2022 were used. Results: In the initial search phase, 2893 articles were obtained. In the next step, after the review of titles and abstracts, 760 articles remained. Finally, based on inclusion criteria and full text review, 14 related articles were selected. Disadvantages of tube feeding methods were classified into four categories: "respiratory complications", "gastrointestinal complications", "metabolic complications" and "bed occupancy". Conclusions: Based on the results of this study, in terms of complications, intermittent and continuous methods are safer and more preferable than the bolus method. However, low-speed bolus feeding has fewer side effects. [ABSTRACT FROM AUTHOR]

Objective: To describe long-term outcomes and complications following mandibular distraction osteogenesis (MDO) in a diverse patient cohort Design: Cross-sectional study Setting: Single tertiary-care pediatric center Patients: Forty-eight patients previously undergoing MDO with minimum 4-year follow-up Main Outcome Measures: Respiratory outcomes, feeding patterns, dental development, motor/sensory nerve function, temporo-mandibular joint function, and postsurgical scarring Results: Forty-six patients with a median age of 7 years were evaluated. Of 20 nonsyndromic patients, none required additional airway procedures, none required continuous positive airway pressure (CPAP) during sleep, and 19 (95%) fed exclusively by mouth. Among 26 syndromic patients, 7 (27%) required CPAP and 8 (31%) were tube fed. Permanent first molar differences were seen in the majority of subjects; patterns of damage interfering with function were more common in syndromic (13/28, 46%) compared to nonsyndromic (5/24, 21%; P =.014) subjects. MDO prior to age two was associated with more frequent and worse dental damage (P =.001). Inferior alveolar nerve and marginal mandibular nerve function were fully intact in 37 (80%) and 39 (85%) of patients, respectively. Three patients (6%), all with associated genetic syndromes, demonstrated severe nerve impairment. By the Vancouver scar scale, ≥ 80% of surgical scars were rated in the most favorable category for each quality assessed. Temporomandibular joint dysfunction was rare. Conclusions: MDO shows highly favorable long-term respiratory, feeding, nerve, and scar outcomes in nonsyndromic patients, although permanent molar changes not precluding tooth viability are commonly seen. Patients with associated syndromes demonstrate respiratory and feeding benefits, but higher rates of dental and nerve abnormalities. [ABSTRACT FROM AUTHOR]

Background: Enteral feeding intolerance, a common type of gastrointestinal dysfunction leading to underfeeding, is associated with increased mortality. Tracheal pepsin A, an indicator of microaspiration, was found in 39% of patients within 24 hours of enteral feeding. Tracheal pepsin A is a potential biomarker of enteral feeding intolerance. Objective: To identify predictors of microaspiration (tracheal or oral pepsin A). It was hypothesized that variables predicting the presence of tracheal pepsin A might be similar to predictors of enteral feeding intolerance. Methods: In this secondary analysis, machine learning models were fit for 283 adults receiving mechanical ventilation who had tracheal and oral aspirates obtained every 12 hours for up to 14 days. Pepsin A levels were measured using the proteolytic enzyme assay method, and values of 6.25 ng/mL or higher were classified as indicating microaspiration. Demographics, comorbidities, and variables associated with enteral feeding were analyzed with 3 machine learning models—random forest, XGBoost, and support vector machines with recursive feature elimination—using 5-fold cross-validation tuning. Results: Random forest for tracheal pepsin A was the best-performing model (area under the curve, 0.844 [95% CI, 0.792-0.897]; accuracy, 87.55%). The top 20 predictors of tracheal pepsin A were identified. Conclusion: Four predictor variables for tracheal pepsin A (microaspiration) are also reported predictors of enteral feeding intolerance, supporting the exploration of tracheal pepsin A as a potential biomarker of enteral feeding intolerance. Identification of predictor variables using machine learning models may facilitate treatment of patients at risk for enteral feeding intolerance. [ABSTRACT FROM AUTHOR]

Background: Therapeutic hypothermia (TH) is the standard treatment for moderate to severe hypoxic–ischemic encephalopathy (HIE) in developed countries, but data on its safety and efficacy in low-middle-income countries are limited and often conflicting. The impact of enteral feeding during TH remains inadequately explored. We aimed to examine TH's effects on mortality and brain injury and evaluate the safety and effectiveness of minimal enteral feeding during TH. Here, we report our single-center experience with TH over a 10-year period". Methods: A total of 187 neonates with moderate to severe HIE who underwent cooling were included in this retrospective study. Post-rewarming MRI scans were scored using a validated MRI scoring system. The primary outcomes were mortality and composite outcomes of mortality and brain injury. Results: The mortality rate was 3% in moderate and 25% in severe cases (p < 0.001). Overall, 85% (160/187) of neonates received minimal enteral nutrition. Multivariate regression analysis revealed that the severity of HIE at admission (OR 3.4 (1.03–11.6); p < 0.04) and gestational age (OR: 0.624 (0.442–0.882); p < 0.008) were independent predictors of composite outcomes of death and brain injuries. MRI score was a strong predictor of mortality (AUC: 0.89; p < 0.001) and of ability to orally feed at discharge (AUC: 0.73; p < 0.001). Conclusions: Mortality rates associated with TH in infants with moderate–severe HIE align with those in high-income countries, and minimal enteral feeding during TH is safe. The severity of HIE, MRI scores, and feeding status are important predictors of outcomes. [ABSTRACT FROM AUTHOR]

Background: Percutaneous Endoscopic Gastrostomy (PEG) tube insertion, a routine procedure for long-term enteral nutrition, serves as a crucial intervention for patients who are incapable of tolerating oral intake or meeting adequate nutritional requirements. PEG tube placement carries complications like bleeding and infection. Impact of PEG tubes on the 30-day and long-term mortality in HIV patients is unknown. Despite the ongoing utilization of PEG tubes in HIV patients, a comprehensive exploration of its outcomes is yet to be explored. We intended to study the impact of HIV positive status on post-PEG mortality and review other PEG tube related complications. Methods: Our study comprised a total of 639 PEG tubes placed on 461 unique patients, from which 85 patients (n = 18%) were HIV positive. We reviewed all these PEG tube patients at our institution and compared their complications and mortality outcome between the two groups of HIV positive as against HIV negative. Results: Our findings reveal a statistically significant increase (p-value 0.001) in post-PEG insertion site bleeding in the HIV group (15.3%) compared to the non-HIV group (4.5%). This difference occurred despite no notable variations in laboratory parameters such as platelet count and (international normalized ratio), as well as similar usage of anticoagulant or antiplatelet medications between the two groups. Notably, the 1-year mortality rate in the HIV group stands at 37.6% (p < 0.001), contrasting sharply with the non-HIV group's rate of 17.8%. Conclusion: This study underscores the need for heightened vigilance and tailored management strategies when considering PEG tube procedures in the context of HIV, given the observed elevated bleeding risks and increased 1-year mortality rates in this patient population. Further research is warranted to elucidate the underlying factors contributing to these outcomes, facilitating the development of targeted interventions to optimize the care of HIV patients undergoing PEG placement. [ABSTRACT FROM AUTHOR]

Non-neoplastic hypercortisolaemia, also known as pseudo-Cushing's syndrome (PCS), is a physiological overactivation of the hypothalamic–pituitary–adrenal axis that can be triggered by conditions such as depression, eating disorders, extreme exercise, obesity, alcoholism, poorly controlled diabetes, chronic kidney disease, and cachexia. Here, we describe an unusual case of pheochromocytoma-induced PCS. A 66-year-old woman was referred to the hospital due to pronounced weakness, loss of appetite, apathy, weight loss, newly diagnosed diabetes mellitus, and poorly controlled hypertension. The biochemical evaluation suggested ACTH-dependent hypercortisolemia with severe hypokalemia, metabolic alkalosis, and hyperglycemia. Markedly elevated levels of metanephrines, along with imaging showing a heterogeneous adrenal lesion, provided evidence for pheochromocytoma. Considering the clinical features and the results of laboratory and imaging tests, there was a suspicion of hypercortisolemia due to ectopic ACTH secretion by a pheochromocytoma. The patient underwent adrenalectomy following pre-treatment with doxazosin and metyrapone, enteral feeding, protein supplementation, and insulin administration. Post-surgery, the patient did not require further antidiabetic medication, experienced gradual weight gain, improved well-being, and did not need glucocorticoid supplementation. Histopathological examination confirmed a pheochromocytoma; however, both anti-ACTH and anti-CRH stainings were negative, leading to a diagnosis of PCS. This case highlights the distinctive presentation of PCS caused by pheochromocytoma, as demonstrated through clinical, laboratory, and histopathological findings, and emphasizes the successful resolution achieved through adrenalectomy and supportive care. [ABSTRACT FROM AUTHOR]

Background: Adequate, balanced, and individualized nutrition, planned according to the patients' life expectancy in palliative care units, is crucial for maintaining essential functions. Aim: To determine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices and their perceptions of nutritional care quality in their units. Methods: This descriptive, cross-sectional study was conducted in 25 palliative care units located in Izmir, Türkiye, between June and September 2022. The study sample consisted of 205 nurses working in palliative care units. Data were collected using a Personal Information Form, an Enteral Nutrition Practices Knowledge Form, and the Nurses' Perceived Nutrition Care Quality Assessment Scale. The STROBE checklist was also utilized. Results: The study found that the majority of participating nurses (94.6%) were female, with 78.5% holding bachelor's degrees. The median knowledge score for enteral nutrition: 15 (range: 2–27), perceived care quality score: 36 (range: 9–45). Those with enteral nutrition training had significantly higher knowledge scores (p <.001); palliative care certificate showed no difference (p =.846). Nurses lacking nutrition counseling knowledge had lower perceived care quality scores (p =.001). Monthly tube feeding applications correlated positively with knowledge scores (r =.173, p =.013), unlike professional experience duration (p =.126) and time spent in palliative care (p =.839). Conclusion: Nurses working in the palliative care unit find the quality of nutrition care provided to patients in their clinics to be sufficient, and the level of knowledge regarding enteral nutrition is at a moderate level. However, in questions related to nursing care such as fluid requirements during enteral nutrition with enteral solutions that affect both nutritional care and medical treatment, maintaining the opening of the jejunostomy tube, and enteral drug administration, correct response rates were low. Low correct response rates on specific issues highlight a need for targeted educational interventions. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis is a significant clinical condition with varying management strategies. This study evaluates the outcomes of conservative management for acute pancreatitis at Katihar Medical College and Hospital (KMCH). METHODS: This prospective cohort study included 35 patients with acute pancreatitis treated conservatively from July 2022 to December 2023. Data on demographic characteristics, management strategies, and clinical outcomes were collected and analyzed. Results: The cohort consisted of 71.4% males and 28.6% females, with a significant recovery rate of 80%. Conservative management strategies included intravenous hydration, pain management, and nutritional support, mainly through enteral feeding. Complications occurred in 20% of the patients, primarily those with severe pancreatitis. The mortality rate was 5%, confined to patients with severe conditions and associated complications. Conclusion: Conservative management of acute pancreatitis at KMCH showed high efficacy in promoting recovery with minimal complications. The study underscores the importance of supportive care and highlights the need for further research on predictive markers for severe cases. [ABSTRACT FROM AUTHOR]

Objectives: Osteosarcopenia is a combination of sarcopenia and osteoporosis that increases mortality rates among older people compared with either alone. This study aimed to identify the contribution of osteosarcopenia to the development and severity of dysphagia. Methods: We retrospectively reviewed the medical charts of 211 patients aged ≥ 65 years who were referred to the dysphagia rehabilitation team. Based on Functional Oral Intake Scale (FOIS) scores, we classified the patients with (FOIS scores 1–5) and without (FOIS scores 6, 7) dysphagia as Type A and those with (FOIS scores 1, 2) and without (FOIS score 3–7) enteral feeding as Type B. Based on chest computed tomography (CT) findings we then defined patients with T4 (MI) and pectoralis (PMI) muscle indexes, L1 attenuation, and T4MI, PMI, and L1 attenuation below the cutoff values as having sarcopenia, osteoporosis, and osteosarcopenia, respectively. Results: The FOIS scores were significantly lower among patients with osteosarcopenia than among those without sarcopenia or osteoporosis. Moreover, PMI and FOIS scores significantly and positively correlated, and PMI was significantly lower in the group with, than without, enteral feeding. Osteoporosis and osteosarcopenia were significant in the patients who were fed enterally (p = 0.032 and 0.047, respectively). Conclusions: Patients with sarcopenia and osteoporosis undergoing swallowing rehabilitation tended to have severe dysphagia that required much medical attention. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The use of blended tube feeding (BTF) in children is a controversial area with persistent concerns regarding the nutritional adequacy and risk of associated infections and equipment complications. Parents in Australia are electing to use BTF in their children despite local hospital guidelines, calling for further research to support its use.A retrospective case‐series study was conducted at a tertiary paediatric hospital, to characterise the paediatric population electively using BTF and evaluate their clinical outcomes. Demographic, anthropometric and clinical data were collected from pre‐existing medical records.Data from 178 clinical visits of 26 participants were included in analysis. The median age of participants was 4.1 years (range 7 months −14 years). BTF was most commonly used for symptom control (n = 8, 30.8%). The most common cause of clinical presentation during the use of BTF was respiratory conditions (number of presentations = 60, 47.2%). There was no reported increase in hospital presentations, gastrointestinal infections or equipment complications with the use of BTF. BTF did not promote weight gain in this population of children, particularly those who were already underweight.This case‐series found the use of BTF in a paediatric population with underlying complex medical conditions requiring enteral nutrition was driven by parental preference and the goals of symptomatic control. BTF did not demonstrate benefits of weight gain, though it was not associated with an increase in complications and hospital admission. [ABSTRACT FROM AUTHOR]

This study compared the efficacy and tolerability of three enteral formulas in critically ill patients with COVID-19 who were ventilated and in the prone position: (a) immunomodulatory (IMM), (b) ω3 and (c) maltodextrins (MD). Primary outcome was the percentage of patients who received both 80 % of their protein and calorie targets at 3 d after enrolment. Secondary, mechanical ventilation-free time, ICU mortality and markers of nutritional status. Tolerance of enteral nutrition was evaluated by diarrhoea and gastroparesis rate. A total of 231 patients were included, primary outcome achieved was in ω3 group (76·5 % v. 59·7 and 35·2 %, P < 0·001) v. IMM and MD groups. Mechanical ventilation-free time was longer in ω3 and MD groups: 23·11 (sd 34·2) h and 22·59 (sd 42·2) h v. 7·9 (sd 22·6) h (P < 0·01) in IMM group. Prealbumin final was 0·203 ± 0·108 g/L and 0·203 ± 0·095 g/L in IMM and ω3 groups v 0·164 ± 0·070 g/L (p < 0·01) MD group. Transferrin were 1·515 ± 0·536 g/L and 1·521 ± 0·500 g/L in IMM and ω3 groups v 1·337 ± 0·483 g/L (p < 0·05) MD group. Increase of lymphocytes was greater in ω3 group: 1056·7 (sd 660·8) cells/mm3 v. 853·3 (sd 435·9) cells/mm3 and 942·7 (sd 675·4) cells/mm3 (P < 0·001) in IMM and MD groups. Diarrhoea and gastroparesis occurred in 5·1 and 3·4 %, respectively. The findings of this study indicate that enteral nutrition is a safe and well-tolerated intervention. The ω3 formula compared with IMM and MD did improve protein and calorie targets. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is an intensivist-led telemedicine-based strategy including daily multidisciplinary rounds combined with monthly audit and feedback able to reduce intensive care unit (ICU) length of stay compared with usual care? Findings: In a cluster randomized clinical trial of 30 ICUs (n = 15 230 patients in the intervention period), multidisciplinary rounds and monthly audit and feedback meetings performed by remote intensivists (tele-ICU) did not significantly reduce the ICU length of stay compared with the standard care group. Meaning: An intervention comprising daily multidisciplinary rounds and monthly audit and feedback meetings performed by board-certified remote intensivists (tele-ICU) had no impact on ICU length of stay. Importance: Despite its implementation in several countries, there has not been a randomized clinical trial to assess whether telemedicine in intensive care units (ICUs) could improve clinical outcomes of critically ill patients. Objective: To determine whether an intervention comprising daily multidisciplinary rounds and monthly audit and feedback meetings performed by a remote board-certified intensivist reduces ICU length of stay (LOS) compared with usual care. Design, Setting, and Participants: A parallel cluster randomized clinical trial with a baseline period in 30 general ICUs in Brazil in which daily multidisciplinary rounds performed by board-certified intensivists were not routinely available. All consecutive adult patients (aged ≥18 years) admitted to the participating ICUs, excluding those admitted due to justice-related issues, were enrolled between June 1, 2019, and April 7, 2021, with last follow-up on July 6, 2021. Intervention: Remote daily multidisciplinary rounds led by a board-certified intensivist through telemedicine, monthly audit and feedback meetings for discussion of ICU performance indicators, and provision of evidence-based clinical protocols. Main Outcomes and Measures: The primary outcome was ICU LOS at the patient level. Secondary outcomes included ICU efficiency, in-hospital mortality, incidence of central line–associated bloodstream infections, ventilator-associated events, catheter-associated urinary tract infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation, and rate of patients with oxygen saturation values under that of normoxemia, assessed using generalized linear mixed models. Results: Among 17 024 patients (1794 in the baseline period and 15 230 in the intervention period), the mean (SD) age was 61 (18) years, 44.7% were female, the median (IQR) Sequential Organ Failure Assessment score was 6 (2-9), and 45.5% were invasively mechanically ventilated at admission. The median (IQR) time under intervention was 20 (16-21) months. Mean (SD) ICU LOS, adjusted for baseline assessment, did not differ significantly between the tele–critical care and usual care groups (8.1 [10.0] and 7.1 [9.0] days; percentage change, 8.2% [95% CI, −5.4% to 23.8%]; P =.24). Results were similar in sensitivity analyses and prespecified subgroups. There were no statistically significant differences in any other secondary or exploratory outcomes. Conclusions and Relevance: Daily multidisciplinary rounds conducted by a board-certified intensivist through telemedicine did not reduce ICU LOS in critically ill adult patients. Trial Registration: ClinicalTrials.gov Identifier: NCT03920501 This parallel cluster randomized clinical trial examines the effect of daily multidisciplinary rounds conducted via telemedicine by a board-certified intensivist on length of stay in the intensive care unit in critically ill adult patients in Brazil. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety study of percutaneous gastroscopic gastrostomy in patients after ventriculoperitoneal shunt. Methods: We conducted a retrospective analysis of neurosurgical patients who underwent VPS and PEG at our hospital between January 2012 and November 2023. Patients were divided into 2 groups: VPS group and VPS followed by PEG gruop. Patients received routine antibiotic prophylaxis before the procedure, continued for 48 hours. Follow-up included monitoring immediate complications, particularly wound infection, intracranial infection, neurologic status deterioration, and shunt dysfunction. Routine follow-up visits were conducted post-discharge. Results: In the VPS group (n = 778), the incidence of intracranial infection was 3.08%. Among patients with PEG after VPS, the time interval between procedures ranged from 13 to 685 days. The mean follow-up period was 22 (1-77) months, with no deaths or further complications. Conclusion: Performing PEG more than 13 days after VPS does not significantly increase the risk of intracranial infections or PEG-associated infections, making it a relatively safe procedure. [ABSTRACT FROM AUTHOR]

The timeline of the 3 Pediatric International Nutrition Studies (PINS) coincided with the publication of 2 major guidelines for the timing of parenteral nutrition (PN) and recommended energy and protein delivery dose. The study's main objective was to describe changes in the nutrition delivery practice recorded in PINS1 and PINS2 (PINS1-2) (conducted in 2009 and 2011, preexposure epoch) vs PINS3 (conducted in 2018, postexposure epoch), in relation to the published practice guidelines. This study is a secondary analysis of data from a multicenter prospective cohort study. Data from 3650 participants, aged 1 month to 18 years, admitted to 100 unique hospitals that participated in 3 PINS was used for this study. The time in days from pediatric intensive care unit admission to the initiation of PN and enteral nutrition delivery were the primary outcomes. Prescribed energy and protein goals were the secondary outcomes. A frailty model with a random intercept per hospital with stratified baseline hazard function by region for the primary outcomes and a mixed-effects negative binomial regression with random intercept per hospital for the secondary outcomes. The proportion of patients receiving enteral nutrition (88.3% vs 80.6%; P <.001) was higher, and those receiving PN (20.6% vs 28.8%; P <.001) was lower in the PINS3 cohort compared with PINS1-2. In the PINS3 cohort, the odds of initiating PN during the first 10 days of pediatric intensive care unit admission were lower, compared with the PINS1-2 cohort (hazard ratio 0.8, 95% CI 0.67 to 0.95; P =.013); and prescribed energy goal was lower compared with the PINS1-2 cohort (incident rate ratio 0.918, 95% CI 0.874 to 0.965; P =.001). The likelihood of initiation of PN delivery significantly decreased during the first 10 days after admission in the PINS3 cohort compared with PINS1-2. Energy goal prescription in children receiving mechanical ventilation significantly decreased in the postguidelines epoch compared with the preguidelines epoch. [ABSTRACT FROM AUTHOR]

Objective: This review examines the progress of research on posaconazole therapeutic drug monitoring (TDM) that has focused on differences in the TDM of posaconazole after clinical application in different formulations and in different populations, the factors that affect posaconazole concentrations, the advantages of posaconazole TDM in terms of clinical efficacy and cost savings, and measurement methods. Methods: A literature search (2006 to 2024) was performed in PubMed and Embase with the following search terms: noxafil, posaconazole hydrate, posaconazole, drug monitoring, therapeutic drug monitoring, and TDM. Abstracts of review articles, prospective studies, and retrospective studies were reviewed. Results: TDM should be implemented earlier for posaconazole tablets and injections than for oral posaconazole suspensions. Posaconazole TDM is beneficial for improving clinical efficacy, and the incidence of breakthrough invasive fungal infections (IFIs) can be significantly reduced by gradually adjusting the posaconazole dose in response to TDM in patients with inadequate trough concentrations. Early TDM allows more patients to achieve target therapeutic posaconazole concentrations. TDM can also facilitate dose adjustments, which reduce the cost of this expensive drug. Different assay techniques, including chromatography, microbiological detection, chemofluorimetry, paper spray mass spectrometry, and capillary electrophoresis, can be used for posaconazole TDM. Conclusions: Posaconazole TDM has potential clinical utility and cost-saving benefits and could improve the outcomes of IFI treatment. [ABSTRACT FROM AUTHOR]

Temple syndrome is a rare imprinting disorder, caused by alterations in the critical imprinted region 14q32 of chromosome 14. It is characterized by pre- and postnatal growth retardation, truncal hypotonia and facial dysmorphism in the neonatal period. We report an 18-year-old girl with a late diagnosis of Temple syndrome presenting with all typical signs and symptoms including small for gestational age at birth, feeding difficulties, muscle hypotonia and delayed developmental milestones, central precocious puberty, truncal obesity and reduced growth. The patient is the second reported in the literature with signs of clinical and biochemical hyperandrogenism and the first treated with Dehydrocortisone®, with a good response. The clinical diagnosis of this patient was made after long-term follow up at a single center for rare endocrine diseases, and a molecular genetics diagnosis of complete hypomethylation of 14q32 chromosome imprinting center (DLK/GTL2) was recently established. Growth hormone treatment was not given and although precocious puberty was treated in line with standard protocols, her final height remained below the target range. Increased awareness of Temple syndrome and timely molecular diagnosis enables improvement of clinical care of these patients as well as prevention of inherent metabolic consequences. [ABSTRACT FROM AUTHOR]

In addition to its established thermoregulatory and cardiovascular effects, heat stress provokes alterations in macronutrient metabolism, gastrointestinal integrity, and appetite. Inadequate energy, carbohydrate, and protein intake have been implicated in reduced exercise and heat tolerance. Classic exercise heat acclimation (HA) protocols employ low-to-moderate–intensity exercise for 5–14 days, while recent studies have evolved the practice by implementing high-intensity and task-specific exercise during HA, which potentially results in impaired post-HA physical performance despite adequate heat adaptations. While there is robust literature demonstrating the performance benefit of various nutritional interventions during intensive training and competition, most HA studies implement few nutritional controls. This review summarizes the relationships between heat stress, HA, and intense exercise in connection with substrate metabolism, gastrointestinal function, and the potential consequences of reduced energy availability. We discuss the potential influence of macronutrient manipulations on HA study outcomes and suggest best practices to implement nutritional controls. [ABSTRACT FROM AUTHOR]

Enteral immune nutrition has attracted considerable attention over the past few years regarding its perioperative role in patients undergoing major surgery for digestive cancer. Today, the term enteral immune nutrition refers to the perioperative administration of nutritional preparations containing, among others, specific ingredients such as glutamine, omega-3 polyunsaturated fatty acids, and arginine. They provide nutritional support and exert pharmacological effects through the substances contained in these preparations. Their administration to patients with gastric cancer is necessary as malnutrition and other metabolic disorders are frequent symptoms with effects on the level of immune responses, affecting the function of intestinal permeability and, therefore, the effectiveness of chemotherapy. Existing clinical data and data from all meta-analyses published so far support the view that enteral immune nutrition enhances the immune responses of gastric cancer patients, and reduces the rate of postoperative complications, and the duration of hospitalization without, however, improving patient survival. The content of enteral immune nutrition, dose, administration interval, and the effect on patient survival should be more precisely determined through relevant extensive multicenter studies. This systematic review describes and analyses the clinical results and the findings of relevant meta-analyses of the application of enteral immune nutrition in gastric cancer patients, emphasize the importance of this therapeutic intervention for disease progression, and attempts to provide practical guidelines for applying enteral immune nutrition in daily clinical practice. [ABSTRACT FROM AUTHOR]

Background/Objectives: Identifying nutritional interventions in extremely low-birth-weight (ELBW) infants (<1000 g) that are associated with favorable clinical outcomes is important. Delayed enteral feeding initiation (>3 days) has been associated with increased odds of developing morbidity. Therefore, the aim of this study is to evaluate the relationship between hour of life at enteral feeding initiation and associated clinical outcomes. Methods: An IRB-approved retrospective chart review evaluated ELBW infants. Birth acuity was evaluated using CRIB II scoring and incidence of various morbidities (bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP)) and mortality was assessed after adjustment. p < 0.05 was statistically significant. Results: A total of 27/61 (44.3%) initiated enteral feeding <12 h of life. CRIB II scores were lower in infants with earlier enteral feeding initiation. There were no statistical differences in NEC, SIP, or death between categories of hour of life at enteral feeding initiation. After adjusting for CRIB II scores, enteral feeding initiation ≥12 h of life was associated with more days receiving oxygen >21% inspired air (β = 32.7; p = 0.040), approximately 7-fold higher odds of developing moderate/severe BPD (95% CI 1.2.8–38.28; p = 0.025), and 9-fold higher odds of being discharged home while receiving oxygen therapy (95% CI 1.03–79.81; p = 0.047). Conclusions: Timing of enteral feeding initiation may be delayed in ELBW infants with higher clinical acuity, yet later initiation by hour of life is associated with worsened clinical respiratory outcomes. Early initiation within the first 12 h of life is feasible and was not associated with gastrointestinal morbidity in this single-center cohort of ELBW infants. [ABSTRACT FROM AUTHOR]

Importance: Gastrointestinal complications are common perioperative complications in children with congenital heart disease (CHD), and as near‐infrared reflectance spectroscopy (NIRS) provides a non‐invasive, real‐time monitoring of regional tissue oxygenation, we envisioned monitoring and preventing the development of gastrointestinal complications through the use of NIRS. Objective: To assess the utility of NIRS for predicting gastrointestinal complication risks and determining optimal initial feeding times in infants post‐cardiac surgery. Methods: This retrospective study included 65 infants with CHD treated at our hospital from January 2021 to January 2022. We collected and analyzed data on mesenteric regional venous and arterial oxygen saturation, arterial partial pressure of oxygen, first lactic acid levels, timing of initial enteral feeding, and incidence of gastrointestinal complications. Results: Out of 65, 61 infants were eligible for inclusion (four cases were excluded). Infants with gastrointestinal complications post‐surgery showed significantly lower mesenteric NIRS values and earlier feeding times compared to those without complications (55.5 ± 3.3 vs. 59.6 ± 6.3, P = 0.029; and 59.8 ± 6.7 vs. 66.9 ± 5.7, P = 0.002, respectively). Multivariable binary logistic regression analysis revealed that mesenteric NIRS readings at the time of initial feeding independently predicted gastrointestinal complications (odds ratio, 0.802; 95% confidence interval, 0.693–0.928; P = 0.003). receiver operating characteristic curve analysis indicated a significant predictive value of mesenteric NIRS at initial feeding time (area under the curve: 0.799), with a suggested critical threshold of 63.1% (93% sensitivity, 70% specificity). Pearson correlation test confirmed a significant association between mesenteric NIRS at initial feeding time and the establishment of enteral feeding. Interpretation: Mesenteric NIRS measurements at the time of initial feeding provide a reliable method for identifying infants at risk of gastrointestinal complications following cardiac surgery and can inform decisions regarding the timing of initial postoperative feeding. [ABSTRACT FROM AUTHOR]

The Royal Brisbane and Women’s Hospital (RBWH) Swallowing and Nutrition Management Guidelines for Patients with Head and Neck Cancer were developed to enable evidence-based decision-making by the Head and Neck Multidisciplinary Team (H&N MDT) regarding enteral nutrition support options. The purpose of this study was to revalidate these guidelines in a cohort of patients receiving helical intensity-modulated radiotherapy (H-IMRT) compared to a historical cohort who received primarily 3D-conformal radiotherapy. Eligible patients attending the RBWH H&N MDT between 2013 and 2014 (n = 315) were assessed by the guidelines, with high-risk patients being recommended proactive gastrostomy tube placement. Data were collected on guideline adherence, gastrostomy tube insertions, the duration of enteral tube use and weight change. Sensitivity, specificity and positive predictive and negative predictive values were calculated and compared with the historical cohort. Overall guideline adherence was 84%, with 60% and 96% adherence to the high-risk and low-risk pathways, respectively. Seventy patients underwent proactive gastrostomy tube placement (n = 62 high-risk; n = 8 low-risk). Validation outcomes were sensitivity 73% (compared to 72%) and specificity 86% (compared to 96%). The guidelines yielded a high sensitivity and specificity, remaining valid in a cohort of patients treated with H-IMRT. Further studies are recommended to improve the sensitivity and understand the decrease in specificity in order to make ongoing guideline improvements.