Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis

Background: A meta‐analysis evaluating surgical outcomes following nutritional provision provided proximal to the anastomosis within 24 hours of gastrointestinal surgery compared with traditional postoperative management was conducted. Methods: Databases were searched to identify randomized controlled trials comparing the outcomes of early and traditional postoperative feeding. Trials involving gastrointestinal tract resection followed by patients receiving nutritionally significant oral or enteral intake within 24 hours after surgery were included for analysis. Results: Fifteen studies involving a total of 1240 patients were analyzed. A statistically significant reduction (45%) in relative odds of total postoperative complications was seen in patients receiving early postoperative feeding (odds ratio [OR] 0.55; confidence interval [CI], 0.35 ?0.87, P = .01). No effect of early feeding was seen with relation to anastomotic dehiscence (OR 0.75; CI, 0.39–1.4, P = .39), mortality (OR 0.71; CI, 0.32–1.56, P = .39), days to passage of flatus (weighted mean difference [WMD] ?0.42; CI, ?1.12 to 0.28, P = .23), first bowel motion (WMD ?0.28; CI, ?1.20 to 0.64, P = .55), or reduced length of stay (WMD ?1.28; CI, ?2.94 to 0.38, P = .13); however, the direction of clinical outcomes favored early feeding. Nasogastric tube reinsertion was less common in traditional feeding interventions (OR 1.48; CI, 0.93–2.35, P = .10). Conclusions: Early postoperative nutrition is associated with significant reductions in total complications compared with traditional postoperative feeding practices and does not negatively affect outcomes such as mortality, anastomotic dehiscence, resumption of bowel function, or hospital length of stay.     

高危儿童的早期教育

该文综述了高危儿童的范畴 ,高危儿童进行早期教育的重要性和生理学基础及对高危儿童进行早期教育的方法及效果评估措施 ,表明对高危儿童进行早期教育将取得良好的效果     

术后舒芬太尼镇痛对开腹手术新生儿术后感染影响

目的分析术后舒芬太尼镇痛对开腹手术新生儿术后感染和炎症反应的影响,为临床感染防控工作提供参考依据。方法选取2014年12月-2016年6月行开腹手术的新生儿150例为研究对象,将其随机分为A、B、C组,每组各50例,A组患儿术后给予6~8μg/kg芬太尼进行镇痛,B组患儿术后给予0.6~0.8μg/kg舒芬太尼进行镇痛,C组患儿术后给予静脉输注生理盐水;对三组患儿的术毕、术后24h的CRIES评分、白细胞计数(WBC)、C-反应蛋白(CRP)水平、白细胞介素-6(IL-6)水平进行观察和比较,对3组患儿术后3~5d内的感染性疾病的发生率、抗菌药物应用时间和住院时间进行观察和比较。结果 C组患者的CRIES评分显著高于A组或B组(P<0.05),而A组与B组患儿的CRIES评分差异无统计学意义;A组与B组患儿术后感染发生率的差异无统计学意义,但均显著低于C组,差异均有统计学意义(P<0.05);B组患儿的抗菌药物应用时间及住院时间均短于A组或C组,差异均有统计学意义(P<0.05);B组患儿的上述炎症标志物水平显著低于A组或C组,差异均有统计学意义(P<0.05)。结论在新生儿开腹手术后应用舒芬太尼进行静脉镇痛,具有较好的镇痛效果,可有效降低患者的感染性疾病发生率,且在减少抗菌药物用量、缓解机体炎症反应水平方面的效果优于应用芬太尼。     

Developmental outcome of high-risk neonates in North Staffordshire

The findings of the developmental outcome of a 2-year follow-up study (1982-1983) on 92 2 1/2-year-old children born in North Staffordshire District are reported. They were assessed by the Griffiths Mental Developmental Scales and all came from a defined geographical area. The babies were all cared for in the Neonatal Unit at the North Staffordshire Maternity Hospital. The group comprised infants weighing less than 1500 g and those of more than 1500 g who required ventilatory support for more than 48 hours. Nine (9.8%) children had major disabilities, including two with severe hearing impairment and two with visual impairment. Disabilities were not attributable to a congenital abnormality or illness acquired after discharge from the neonatal unit.     

Early postoperative enteral feeding by a needle catheter jejunostomy after 100 oesophageal resections and reconstructions for cancer

After oesophageal resection and reconstruction oral feeding is excluded for a long period of time. Since dysphagia is found in most patients with an oesophageal cancer and therefore weight loss very common in these patients, early postoperative feeding seems logical.In the period between August 1980 and February 1983, needle catheter jejunostomy (NCJ) was introduced in 100 consecutive patients operated upon for oesophageal cancer. Reconstruction was performed in all patients during the same operation. Feeding was started in 97 patients, in 71% within 48 h postoperatively. Postoperative mortality was 9% in this group of patients, only one patient died possibly in relation to NCJ.Mean duration of feeding by NCJ was 15.6 days (range 2–84 days). Complications seen were diarrhoea (28%), intraperitoneal leakege (2%) and ileus (2%).Total number of feeding days in this group was 1502 days. Since NCJ feeding costs US $40 less than TPN per feeding day total savings for a 12 600 Joule intake was more than US $60 000.It is concluded that NCJ feeding is an economical and safe procedure after oesophageal resection and reconstruction for cancer.     

Complications and long-term outcome of 80 oncology patients undergoing needle catheter jejunostomy placement for early postoperative enteral feeding

Some findings suggest that needle catheter jejunostomy (NCJ) is associated with a significant rate of potentially dangerous complications. The purpose of this study was to prospectively evaluate the rate and type of early and late complications associated with NCJ in patients with surgical treatment of upper gastrointestinal malignancy. Eighty patients underwent NCJ implant at the end of their scheduled surgical procedure. Enteral nutrition programme was started on postoperative day 1 in the surgical ICU. NCJ was always removed in the outpatient clinic after hospital discharge. One case of tube blockage has been observed as single short-term complication in this series. No long-term complications have been detected after a mean follow-up of 12 months.Routine use of NCJ in malnourished patients undergoing major surgical procedures on upper gastrointestinal tract is safe and effective.     

回肠造瘘术后新生儿生长速度及短期营养结局

目的　了解营养支持对新生儿期行回肠造瘘术后短期生长速度和营养结局的影响。方法　手术患儿来源于2010年9月至2014年9月在广州市妇女儿童医疗中心新生儿外科收治后行回肠造瘘术者,出院后至门诊接受营养支持和指导,每月监测体质量、身长和头围至9月龄,与同时期门诊日常保健的无手术婴儿进行对照。计算患儿每月生长速度,与WHO标准进行比较,寻找生长加速期。结果　新生儿手术后1个月时体质量增长速率低于正常参考值,男性的体质量增长速率与正常值差异有统计学意义（P=0.001）,男女患儿均在3月龄时出现体质量增长速度明显提高（P=0.033,P=0.003）。5月龄后,手术患儿体格已接近对照组同龄儿。结论　回肠造瘘术后患儿生长加速期可能出现在3月龄,5～9月龄体格水平接近同龄婴儿。     

Inadequate intravenous feeding in sick neonates: a retrospective study

It is a common experience that during intravenous feeding (IVF) in neonates the administered amounts do not always meet the recommendations. In an attempt to quantify these deficits and to determine the causes we studied the data of 2 comparable groups of neonates admitted to a neonatal intensive care unit (NICU). In Group 1 (N = 107; gestational age 25-42 weeks; birth weight 690-5920 g) the minimum recommended intake of energy (70 kCal/kg/d) and of aminoacids (2.5g/kg/d) was not met in 17% and in 71% respectively. The main causes of inadequate intake were believed to be the nearly exclusive use of peripheral venous access, and the restriction in glucose and/or lipid administration because of extreme prematurity and/or severe illness. In Group 2 (N = 99; gestational age 24-42 weeks; birth weight 670-4300 g), where these causes were corrected, 11% and 54% of the patients still received an insufficient amount of energy and amino acids respectively. It can be concluded that in the daily practice in a NICU, even in optimal conditions and following the recent recommendations for IVF, a considerable proportion of preterm neonates do not receive the minimal recommended amount of energy and aminoacids.     

新生儿高促甲状腺素血症446例临床转归研究

目的 通过对新生儿高促甲状腺素血症患儿转归的研究,为先天性甲状腺功能减低症的治疗工作提供依据。 方法 对446例经新生儿疾病筛查可疑先天性甲状腺功能减低症、第1次就诊时静脉血清促甲状腺激素(thyrotropin,TSH)浓度为5~20 mU/L、FT4浓度正常的新生儿随访至3~6岁后,评估体格发育情况与甲状腺功能。 结果 1)经3~6年随访,最后确诊永久性甲状腺功能低下1例,高TSH血症16例,甲状腺功能完全正常429例;2)随访起始与结束时TSH浓度比较,Z值分别为:2.90,5.41,6.45,P值均为＜0.01。 结论 经新生儿疾病筛查的高TSH血症患儿多数可恢复正常,少数应严密随访,以早期确诊及治疗。     

新生儿感染性休克的早期临床信号与病原分析

目的探讨新生儿感染性休克的早期信号与伴随症状,为临床早诊断、早治疗提供参考。方法回顾性分析某院2001年1月-2009年3月住院且符合感染性休克诊断标准的31例患儿资料。结果拒乳或吸乳量减少（29例,93.55%）、精神差（24例,77.42%）、烦躁（20例,64.52%）与反复青紫（11例,35.48%）为新生儿感染性休克的早期表现;出现早期表现后,病情进展迅速,大部分(27例,87.10%)在发病24 h内即进入休克期。新生儿感染性休克病死率（19例,61.29%）高,2001-2005年,17例新生儿病死14例（82.35%）;2006-2009年,14例新生儿病死5例（35.71%）,两阶段比较,差异有高度显著性（χ2=77.04,P=0.008）。结论拒乳或吸乳量减少、精神差、烦躁及反复青紫是新生儿感染性休克的早期信号。及时识别和恰当的治疗可以挽救新生儿的生命。     

Early feeding problems in a normal population

The prevalence of parentally experienced infant feeding problems was explored in two samples (N = 841 and N = 567) of infants, aged between 30 and 71 weeks. Correlates to specific problem types were sought. One-fourth of the parents had experienced feeding problems during the infant's first 6 months and more than 10% reported ongoing problems. Colic was the most commonly reported early appearing problem, while refusal of solids, poor appetite, and general refusal to eat were the most common problems after the first 6 months. Maternal health factors, severe and longlasting breastfeeding problems, and problematic mealtime behaviors were associated with colic, while vomiting was only related to breastfeeding problems. The refusal-to-eat group presented the largest number of correlates including family feeding problems, problematic meal behaviors, and health problems. The only aspects distinguishing all problem groups from controls were parental anxiety about infant health and sibling feeding problems.     

Early enteral gut feeding with conditionally indispensable pharmaconutrients is metabolically safe and is well tolerated in postoperative cancer patients--a pilot study

BACKGROUND & AIMS: Postoperative early enteral gut feeding with conditionally indispensable pharmaconutrients can contribute to minimize trauma-induced gut damage. Aim of this pilot study was the evaluation of metabolic effects and gastrointestinal tolerance of a new enteral supplement. METHODS: In a prospective open clinical trial, 20 cancer patients received the test supplement containing glutamine (as dipeptides), antioxidative (pro-)vitamins (C, E, beta-carotene), maltodextrine, tributyrine, sodium, zinc, and selenium within 2-3 h after elective gastrointestinal surgery continuously via jejunostomy tube for 3 postoperative days (500 ml/day). From postoperative day 3-5, additional enteral nutrition (1500 kcal/6270 kJ/day) was given. Metabolic effects (substrate monitoring, hematology, liver/kidney parameters) and tolerance (nausea, vomiting, flatulence, constipation, diarrhea) was assessed through the study. RESULTS: Gastrointestinal tolerance of the supplement was excellent: no adverse events related to the product were documented. Significantly increased mean plasma levels (day 3 vs. day 1) of vitamin C (13.0 +/- 7.3 vs. 62.8 +/- 29.7 micromol/l), vitamin E (13.5 +/- 6.6 vs. 20.8 +/- 9.2 micromol/l), zinc (5.6 +/- 1.9 vs. 8.6 +/- 2.3 micromol/l) and selenium (35.0 +/- 19.6 vs. 42.9 +/- 0.9 microg/l) as well as enhanced plasma glutamine levels (429.6 +/- 90.6 vs. 530 +/- 200.1 micromol/l) reflected an effective absorption of substrates supplied. Adverse effects on organ functions and hematology were not observed. CONCLUSIONS: Early postoperative gut feeding with the newly developed enteral supplement shows no adverse effects, is well tolerated in cancer patients and provides a novel method to deliver conditionally indispensable pharmaconutrients.     

Early infant feeding and type 1 diabetes

Background  Infant feeding practices, particularly the type of milk feeding, have been associated with the development of type 1 diabetes. Aim of the study  We studied the relationship between early infant feeding (during the first year of life) and diabetes in a large population-based cohort. Methods  In 1994–1995, 6,209 healthy full-term newborns participated in a study examining the effect of supplementary feeding, on development of allergy to cow’s milk, in maternity hospitals. All supplements in the maternity hospitals were known. Mothers recorded the feeding of infants prospectively at home. In August 2006, from a nationwide diabetes registry, 45 children from our cohort were listed as having type 1 diabetes. Results  The distribution of cases was similar in the randomized feeding groups: 9/1,789 in the group that received adapted cow’s milk-based formula; 12/1,737 in those who received extensively hydrolyzed formula; 16/1,859 in those who received banked human milk; and 8 among those 824 exclusively breast-fed in the hospital. When children who had received cow’s milk-based formula in the maternity hospital were compared with those without such exposure, less number of children in the former group had diabetes by age 8 (P = 0.026), but by the end of the follow-up (11.5 years) the difference disappeared (P = 0.16). Length of breast-feeding and introduction of cereals and other solid foods were similar among those developing type 1 diabetes and those remaining healthy, while early regular daily feeding with cow’s milk-based formula tended to associate with lower risk for type 1 diabetes (OR 0.66; 95% confidence interval 0.38–1.13; P = 0.08). Conclusions  In an extended, secondary analysis of a population-based cohort, very early exposure to cow’s milk is not a risk factor for type 1 diabetes; it may in fact diminish its appearance before age 8.     

Early enteral feeding in newborn surgical patients

OBJECTIVE: We report the results of a multicenter prospective trial of early enteral trophic feeding in a group of 56 neonates who required abdominal surgery for a variety of congenital anomalies. METHODS: In this clinical study, 33 neonates were fed in the early postoperative period (early enteral nutrition [EEN] group), and the remaining 23 (control [C] group) were fasted until resolution of postoperative ileus. Patients in the EEN group (Kocaeli feeding protocol) received 3 to 5 mL of breast milk every hour through a nasogastric feeding tube, starting a mean of 12 h (8 to 20 h) after surgery. The nasogastric tube was clamped for 40 min after each infusion and then opened for drainage. Groups were further divided into two subgroups according to whether an intestinal anastomosis or laparotomy was performed. The change in daily gastric drainage, time to first stool, day of toleration to full oral feeding, and length of hospital stay were compared. Blood bilirubin levels, white blood cell count, and C-reactive protein levels were monitored. RESULTS: The time to first stool and day of toleration to full oral feeding occurred significantly sooner, whereas nasogastric tube drainage duration and hospital stay were significantly shorter in the EEN-anastomosis group than in the C-anastomosis group. Time to first stool occurred significantly sooner in the EEN-laparotomy group than in the C-laparotomy group, although other parameters did not differ. Neither anastomotic leakage nor dehiscence was observed in any group. There were two cases of wound infection and two of exitus among patients in the C group. CONCLUSION: Postoperative, early intragastric, small-volume breast milk feeding is well tolerated by newborns. It is a reliable and feasible approach in neonates even in the presence of an intestinal anastomosis after abdominal surgery.     

The importance of early postoperative enteral feeding

There are still many uncertainties about giving early postoperative enteral nutrition to patients undergoingmajor abdominal surgery. In this article we describe some possible benefits of early feeding through a brief review of the literature and results from a placebo-controlled study of early postoperative enteral feeding in patients undergoing predominantly lower gastrointestinal surgery. This study showed a reduction of postoperative infections. Other studies have not been able to show the same benefit. Possible reasons for these discrepant findings are discussed. In certain situations, early postoperative nutrition may be cost-effective because of fewer re-operations, fewer days in the intensive care unit, and fewer infections. Previously unpublished data suggest that enteral nutrition has an influence upon the postoperative shift of fluid which may be an important mechanism explaining its effects. One of the greatest barriers to the introduction of early postoperative nutrition into a surgical department seems to be the disagreement among surgeons about this procedure and its relevance. Results from a Danish department show that it is possible to administer about 90% of the required daily energy intake during the first 2 postoperative days after acute and elective abdominal surgery through the use of a nasoduodenal tube.     

Transpyloric feeding in the newborn: use in neonates with and without respiratory failure

In a peripheral maternity hospital providing Intensive Care for 5274 deliveries per annum, NJ feeding was attempted, in one year, in 57 neonates. One third of these weighed less than 1500 g at birth and 41 (71.9%) had respiratory disease. A standard technique, and a commercially available tube was used, and the tube was passed to the jejunum within 24 hours in 46 (80.7%) of the babies. NJ feeding was continued for varying periods, up to 50 days. The volume of milk given varied with the duration of the feed but feeds of up to 244 ml of milk/Kg body weight/day were achieved. Thirty-eight (66.6%) of the babies regained their birthweight by 20 days and major complications were uncommon. We have shown that NJ feeding can be used in low birthweight babies with serious respiratory illness, even when resources are limited.