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Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors. [ABSTRACT FROM AUTHOR]

Background: Home enteral nutrition (HEN) use continues to increase in children unable to meet nutritional needs through oral intake. Some patients do not tolerate standard polymeric formula (SPF), which may lead to malnutrition. Use of peptide‐based diet (PBD) has demonstrated benefits in adults, however there remains a paucity of data in pediatric population. Methods: Retrospective review of medical records of children receiving HEN between October 2015 and October 2019 was conducted. Nutrition, tolerance, and healthcare utilization was tracked through May 2020. Children receiving PBD as initial formula or transitioned to PBD from SPF were included. Our objective was to assess gastrointestinal tolerance and impact on healthcare utilization in children receiving PBD. Results: During study period, 30 children (mean age, 9 ± 5.44 years; 20 of 30 [66.7%] male) utilized PBDs. Twenty‐one patients started PBD directly with malnutrition as primary indication. Nine patients transitioned from SPF to PBD, most often due to intolerance of SPF (66%). After transition to PBD, no symptoms were reported in 6 of 9 (66.7%) patients, and symptoms of SPF intolerance resolved in 4 of 9 (44.5%) patients. Healthcare utilization declined significantly after transition to PBD, including mean numbers of emergency room visits (0.78 ± 1.09 to 0.11 ± 0.33; P =.025), provider visits (1.67 ± 1.32 to 0.56 ± 0.73; P =.007), and phone calls (1.22 ± 1.39 to 0.33 ± 0.50; P =.026). Conclusions: PBD is well tolerated and can result in significant reduction in healthcare utilization in children intolerant to SPF. [ABSTRACT FROM AUTHOR]

Background: Since initial report in 1972, misconnections continue to be an issue, especially in hospitalized patients with multiple access devices. A new small-bore connector standard (ENFit) has been proposed in order to minimize misconnections.Methods: Commercially available finalized ENFit tubes of a variety of sizes (14 French [Fr] size, 18Fr, 20Fr, 24Fr, and low-profile) were obtained for current testing. Variety of commercially available formulas including blenderized tube feeding (BTF) products (Jevity 1 Cal, Abbott Nutrition, Abbott Park, IL; Nourish, Functional Formularies, Centerville, OH; Real Food Blends, Chesterton, IN) were tested.Results: Data from individual measurements were aggregated for ENFit and legacy tubes and revealed higher syringe compression force in legacy tubes compared with ENFit tubes for 20Fr size with Jevity formula. Our institution's BTF formula revealed that legacy tubes had lower syringe compression force than ENFit tubes for 14Fr tube size. Remaining measurements revealed no significant difference. Model 1 of regression analysis revealed that only formula and tube size were significant with R2 of 0.63. Model 2 evaluating the impact of tube size, blender, time of blending, and legacy vs ENFit revealed that tube size, blender used, and blending time were significant with legacy vs ENFit being nonsignificant (R2 of 0.72).Conclusions: Overall, only a small number of tube sizes (14Fr and 20Fr) with selected formulas revealed a significant difference between ENFit and Legacy tubes, with remaining studies finding no significant difference. Regression analysis revealed that variables such as formula, size of tube, blender used, and time of blending may have more impact on compression force. [ABSTRACT FROM AUTHOR]

Background: With data demonstrating benefit, the prevalence of home enteral nutrition (HEN) has increased significantly over the last few decades. Despite this increase, there remains a paucity of data regarding real-world use of HEN including clinical outcomes and complications., Methods: Descriptive analysis of prospectively maintained database of our specialized HEN program was undertaken. Patients who received care in our program with HEN initiation date between January 1, 2018, and December 31, 2020, were included in the analysis. Data regarding demographic information, anthropometrics, enteral nutrition (EN) regimen, electrolytes, and nutrition therapy history were included and tracked until July 31, 2021., Results: During the study period, 1600 patients initiated HEN treatment under our care. Majority of the study population needed EN therapy due to malignancy and its complications, including malignant dysphagia or mechanical obstruction (60.6%) followed by neurodegenerative diseases (7.5%). By the end of the study period, a majority of the patients (82%) stopped HEN treatment. Of these, 44.2% achieved EN goals and/or oral autonomy. Patients continued HEN treatment for a median of 100 (interquartile range, 32-301) days. Overall, 53.2% of patients experienced/reported at least one HEN-related complication that was clinically managed by the HEN team. Complications included tube-related, enteral feeding intolerance (EFI), and electrolyte shifts., Conclusion: In our study population, HEN was most utilized to manage malignancy-related complications, including dysphagia. Unfortunately, complications, including EFI and tube-related complications, remained quite prevalent. Further evaluation regarding risk factors for complications and preventive mechanisms, such as increased education, is indicated., (© 2023 American Society for Parenteral and Enteral Nutrition.)

Purpose: The increased prevalence of home enteral nutrition (HEN), reemergence of blenderized tube feeding (BTF), and conversion of enteral connectors to the ISO 80369-3 standard are creating a significant need to better understand the practices of the HEN population. A cross-sectional survey of current HEN consumers was conducted to evaluate the demographics of HEN consumers, including formulas and feeding tubes being used., Methods: In order to disseminate the survey to a wide range of HEN consumers, we partnered with private infusion companies (Coram and Pediatric Home Services) along with the Oley and Tube Feeding Awareness Foundations. A validated survey focusing on patient demographics, tube types, formula used, and tube clogging complications was placed online from September 1, 2016, to October 15, 2016., Results: During the study period, 1519 surveys were completed, with 1062 respondents in the pediatric group (<18 years old) and 457 in the adult group (≥18 years old). The most popular formulas were standard polymeric and specialized formulas in both the pediatric and adult groups. However, a significant number in the pediatric (31.2%) and adult (18.6%) groups used BTF either alone or in combination with other formulas. Clogging was also quite prevalent and correlated with tube size., Conclusions: The present study highlights the significant diversity of the HEN practice in terms of types and sizes of tubes as well as formulas used, including confirmation of the widespread use of BTF. These data are key to ensure HEN providers are able to appropriately support and educate their patients., (© 2019 American Society for Parenteral and Enteral Nutrition.)

Background: Misconnections between enteral supplies and other access devices have led to significant morbidity and mortality. To reduce misconnections, a standard small-bore connector has been developed (International Organization for Standards 80369-8; ENFit). The full impact of transition to this connector is not known, however., Method: Working with major manufacturers and Food and Drug Administration, we obtained ENFit and comparative legacy tubes of variable sizes (low-profile, 14F, 18F, 20F, and 24F balloon gastrostomies). Gravity enteral feeding was simulated with an empty bolus syringe attached to the feeding tube to be tested. The tube was clamped and filled to the 60-mL mark with liquid (water, Jevity 1 Cal, Isosource HN, Isosource 1.5 Cal, Two Cal HN, and Nourish). The clamp was released, and time for formula to leave the syringe was recorded., Results: There was no difference in flow rate between the aggregate legacy and ENFit tubes for the low-profile, 18F, and 20F sizes. The ENFit 14F tubes had a lower flow rate vs the legacy tubes, largely due to the low flow rates seen with the 1 ENFit tube. Similarly, 24F ENFit tubes with some formulas yielded lower flow rates as opposed to legacy., Conclusion: Overall, for the low-profile, 18F, and 20F sizes, the ENFit tubes had similar flow rates when compared with the legacy tubes. For the 14F and 24F sizes, the flow rate of ENFit tubes was significantly lower, which could result in longer EN delivery for patients who are using these tubes to provide gravity feeding., (© 2017 American Society for Parenteral and Enteral Nutrition.)