Clinical trial of a paediatric enteral feed

A paediatric enteral feed, Paediasure, was given to children aged 1–8 years needing nutritional support. Those who had more than 60% of their energy from Paediasure were included in the trial which ran for 1–3 months. Anthropometric measurements were done at the start and at the end of the trial. Nutritional evaluations of Paediasure were made and compared with other enteral feeds.
It was found that children's growth was satisfactory on Paediasure, that it was well tolerated and palatable if given orally. Paediasure has a high-nutrient density so when given at low volumes (which are required for overweight and some very underweight patients) the recommended nutrient intakes (RNI) are more likely to be met than if other enteral feeds are used.     

肾病型肠内营养制剂在维持性血液透析并发营养不良病人中的疗效分析

目的:观察肾病型肠内营养(EN)制剂在改善维持性血液透析(MHD)并发营养不良病人营养状态的有效性. 方法:选取MHD并发营养不良的病人80例,随机分为观察组和对照组.病人在常规血液透析基础上(2～3次/周),观察组应用肾病型EN制剂治疗6个月,对照组给予单纯饮食指导.分别于营养治疗开始、3个月和结束时观察两组病人的主观综合营养评估(SGA),人体成分分析指标(体重、肌肉、蛋白质、脂肪、水分和BMI),生化指标(血清清蛋白、前清蛋白、肌酐、尿素)和透析充分性指标尿素清除率(Kt/V)等. 结果:病人营养治疗后SGA、体重、肌肉、蛋白质、脂肪、水分、BMI、清蛋白、前清蛋白较治疗前明显升高(P＜0.05);血肌酐、尿素和Kt/V治疗前后无显著性差异(P＞0.05).观察组病人SGA、体重、肌肉、蛋白质、脂肪、BMI、清蛋白和前清蛋白较对照组升高,两组间比较有显著性差异(P＜0.05);而血肌酐、尿素、水分和K∥V无显著性差异(P＞0.05). 结论:肾病型肠内营养制剂可有效地改善维持性血液透析合并营养不良病人的营养状况.     

The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition

Background: The prevalence of malnutrition in the hospitalized setting is 30% to 55%. Previous studies reported an association of malnutrition with an increased hospital length of stay (LOS), morbidity, and mortality of patients. This study evaluated the role of early nutrition intervention on LOS, diagnosis coding of malnutrition cases, calculating case mix index, and reducing delays in implementing nutrition support to patients. Methods: Demographic data, anthropometric measurements, LOS, and serum albumin levels were collected from 400 patients in 2 medical wards to determine the prevalence of malnutrition and potential delays in nutrition consultation. Based on these results, a nutrition intervention study was conducted in 1 ward; the other ward served as a control. Patients were classified as normally nourished or malnourished. Multivariate general linear regressions were used to reveal the impact of intervention on the change in LOS, controlling for other potential confounding factors on the cohort and a subset with severe malnutrition. Results: Of the 400 patients assessed, 53% had malnutrition. Multiple general linear regressions showed that nutrition intervention reduced LOS an average of 1.93 days in the cohort group and 3.2 days in the severe malnourished group. Case mix index and female gender were positively associated with LOS in the malnourished group. Nutrition intervention reduced the delays in implementing nutrition support to patients by 47%. Conclusions: Results highlight the positive impact of nutrition intervention in terms of reduced LOS in malnourished hospital patients. Reduction in LOS with diagnosis coding of malnutrition cases yielded substantial economic benefits.     

Postoperative enteral immunonutrition in head and neck cancer patients

AIMS: to determine if postoperative feeding of head and neck cancer patients, using an enteral diet supplemented with arginine, improves immunological and nutritional status, and clinical outcome, i.e., reduces postoperative infectious/wound complications and length of stay, when compared with an isocaloric, isonitrogenous control diet. METHODS: at operation 44 patients were randomized into two groups to receive: a) an enriched diet (n=23);b) an isocaloric, isonitrogenous control diet (n=21). Thirteen patients with a history of significant weight loss (> or = 10% over the last 6 months) were considered malnourished. Preoperatively and on postoperative days 1, 4 and 8 the following parameters were evaluated: albumin, prealbumin, transferrin, total number of lymphocytes, lymphocyte subsets (CD3, CD4, CD8 and CD4/CD8 ratio) and immunoglobulins. Postoperative complications and length of stay were recorded. RESULTS: 'visceral' serum proteins and immunological parameters decreased on postoperative day 1 in both groups. However, only the enriched group demonstrated a significant increase (P<0.05) in the total number of lymphocytes, CD4, CD4/CD8 on postoperative day 4, and total number of lymphocytes, CD3, CD4, CD4/CD8 on postoperative day 8. In the malnourished subgroup the administration of the enriched formula significantly reduced both postoperative infectious/wound complications and length of stay compared with the control group (P<0.05). CONCLUSIONS: enteral immunonutrition of head and neck cancer patients improves postoperative immunological response. Significant clinical advantages were observed in malnourished patients.     

免疫肠内营养联合生长激素在呼吸机依赖合并营养不良危重症病人中的应用

目的:探讨免疫肠内营养(IEN)联合生长激素(GH)在呼吸机依赖合并营养不良危重症病人中的应用效果。方法:采用前瞻、随机、对照的方法分为三组,即A组给予标准营养支持治疗;B组给予GH治疗;C组给予IEN制剂(瑞能)联合GH治疗。三组病人均于治疗前和治疗后第14天分别测定血清总蛋白(TP)、清蛋白(ALB)、血糖峰值,外周血淋巴细胞总数(TLC),并统计胰岛素日用量、机械通气时间和ICU入住时间等。结果:与A组比较,C组病人的血清TP、ALB和TLC的水平明显升高(P0.05),血糖峰值未见明显变化(P0.05);与B组比较,C组胰岛素日用量明显减少,TLC和ALB明显升高(P0.05)。C组的机械通气时间和ICU入住时间均明显短于A组和B组(P0.05)。结论:IEN联合应用GH能促进营养不良导致呼吸机依赖病人的蛋白质合成,改善营养状况,提高免疫功能,促进脱机,改善预后。     

食管、贲门癌切除术后早期肠内营养的应用

目的：探讨食管、贲门癌术后早期肠内营养的可行性、安全性和临床效果，并与常规补液作一比较。方法：42例食管、贲门癌病人术后第1天随机分为肠内营养（EN组，n=24)和普通输液（对照组，n=18)两组，并分别在营养支持前后各测定一次体重、肝肾功能、血糖、电解质、血清蛋白、血红蛋白、免疫球蛋白，临床观察生命体征、胃肠道功能恢复情况及各种不良反应。结果：两组病例在观察期间无死亡、无严重并发症，肝肾功能无明显变化。EN组血清白蛋白、前白蛋白和转铁蛋白水平营养支持后明显升高（P＜0．01），体重下降减慢。同时EN组肛门恢复排气时间较对照组显著缩短。结论：食管、贲门癌术后早期肠内营养支持安全、可行，在改善机体营养状态方面有显著作用，并可促进和维护胃肠道功能，且费用较低。     

Accuracy of home enteral feed preparation for children with inherited metabolic disorders

Background: Many children with rare chronic disorders require home enteral tube feeds (HETF) consisting of multiple modular ingredients. Feeds are often complex and the risk of errors during their preparation is high. The consequences of over‐ or under‐concentration can be critical. The aim of the present prospective observation study was to assess the accuracy, skills and technique of caregivers when preparing and administering HETF. Methods: Fifty‐two HETF patients (median age 7.5 years, range 0.7–18.0 years) with inherited metabolic disorders (IMD) requiring special feeds were recruited. Using observation and a structured questionnaire, a practical assessment of feed preparation and storage by the main caregiver was undertaken by an independent dietitian and nurse in the child’s home, including hygiene practices, accuracy of measuring recipe ingredients, and storage of both ingredients and prepared feeds. Results: The majority (85%; n = 44) of feeds were based on >1 ingredient (median 3; range 1–6). Almost half (48%; n = 25) of caregivers measured feed ingredients inaccurately. Of the 31% (n = 16) using scoops, 31% used incorrect measuring spoons and 25% did not level scoops appropriately. Some 45% (n = 20/44) of carers measured liquid ingredients inaccurately. Hygiene practices during feed preparation were poor, including a lack of hand washing (31%: n = 16) and incorrect storage procedures for unused feed ingredients (56%; n = 29). Conclusions: Practices in the preparation of modular HETF for children with IMD were not ideal. A combination of inaccuracy, poor hygiene, inappropriate storage, and long feed hanging times increases both metabolic and microbial risk. Better education, regular monitoring and the development of ready‐to‐use or preweighed ingredients would be beneficial.     

How much of the prescribed volume of enteral feed does the hospitalized patient actually receive?

This pilot study was carried out to establish how many interruptions occurred to patients receiving continuous enteral feeding regimens and the associated percentage of feed losses. It measured how much of a prescribed volume of feed patients actually received during a period of enteral nutritional support. The data for 15 patients (medical and surgical) who were maintained on a standard feeding regimen for a minimum period of five days (range 5–10 days) were analysed. All feeds were administered using Abbott Flexiflo enteral feeding pumps. The patients' weight and serum albumin values were recorded prior to, and at the end of, the study. Although all patients received significantly less feed than had been prescribed there were no significant changes in either of these variables.     

Application of Hazard Analysis Critical Control Points system to enteral tube feeding in hospital

An HACCP system was implemented for the quality assurance of preparation, storage and delivery of enteral feeds to patients in hospital. Routine methods of feed preparation, storage and delivery to patients were studied and a flow chart was initially made. After identifying hazards, an HACCP team was assembled, a flow chart was modified and critical control points were defined using a decision tree. Control measures for each step of the process and its monitoring and corrective measures to be applied were also defined. In addition, feed samples were analysed for microbiological quality and feed storage temperatures were also recorded, before and after the implementation of the HACCP system. When the control measures were applied and monitored, the hazard was reduced. Bacterial counts in feed were reduced from 10⁵ cfu mL^–1 to < 10¹ cfu mL^–1. The results show that contamination of enteral feed may be reduced or eliminated if a systematic approach such as HACCP is applied effectively.     

食管、贲门癌病人术后早期肠内营养治疗的分析

目的:总结食管、贲门癌切除术后早期进行肠内营养(EN)的临床效果.方法:回顾性分析106例食管、贲门癌病人术后早期经十二指肠营养管进行EN的临床资料.结果:所有病人未出现吻合口瘘、低蛋白血症等严重并发症,均治愈出院.结论:食管、贲门癌切除病人经十二指肠营养管行EN,能促进和维护胃肠道功能,改善营养状态,并且安全、实用.     

肠内营养支持时机对重型颅脑损伤病人术后并发感染的影响

目的:探讨早期肠内营养(EEN)与延迟肠内营养(DEN)对重型颅脑损伤术后病人并发感染的影响.方法:将85例重型颅脑损伤病人随机分成EEN组和DEN组,分析两组病人术后感染的发生率、持续时间和部位等与结局有关的参数,并比较两者问的差异. 结果:两组病人术后感染发生率和感染持续时间无显著性差异(P>0.05). 结论:营...     

Effect of erythropoietin and testosterone on bone marrow RNA synthesis in rats with protein-energy or protein malnutrition

RNA synthesis was studied in bone marrow of rats with protein-energy malnutrition (PEM) and protein malnutrition (PM) after the administration of erythro-poietin (Epo) and/or testosterone (Te). RNA synthesis appeared slighty increased in PEM animals, 25% by Epo; 66% by Te while not alteration was induced by Epo and Te together. In PM rats a considerable decrease of RNA synthesis was observed. These results would indicate that the use of ¹⁴C-formate as a labelled precursor to estimate DE NOVO RNA synthesis is a reliable experimental variable for testing bone marrow function. The data presented suggest that while in PEM the biochemical machinery required to synthesize RNA remains basically unchanged. PM induces important metabolic disturbance.     

The impact of home enteral tube feeding in everyday life: a qualitative study

Advances in clinical and technical areas, combined with developments in community support services, have enabled people to receive enteral tube feeding at home in the UK. Research has focused on clinical and technical aspects, and people's experiences have largely been explored through the audit of after-care services. The research reported in the present paper consisted of a qualitative study in which a small number of people under going enteral tube feeding at home and their carers were interviewed. The study took place in one area of northern England. The interviews explored aspects of daily life, focusing on decision-making and adaptation, and revealed positive feelings about the process of tube feeding, as well as areas of difficulty and concern. Opportunities to improve practice and services are identified from these accounts.     

早期肠内营养在肝移植术后的应用

目的：探讨肝移植术后的营养支持处理。方法：为2例肝移植术后病人提供早期肠内营养。结果：2例病人现已分别术后9个月和10个月，未发生排斥反应，生活质量和移植物功能良好。结论：肝移植术后早期肠内营养安全，有效。     

Evaluation of hospitalisation for indigenous children with malnutrition living in central Australia

OBJECTIVE: To evaluate the effectiveness of hospital admissions for indigenous children with malnutrition in a rural/remote Australian centre. DESIGN: Retrospective review of the medical records. SETTING: Rural secondary hospital. SUBJECTS: Remote and rural indigenous children aged less than four years managed for malnutrition in Alice Springs Hospital (ASH). MAIN OUTCOME MEASURE: The primary outcome measure was weight gain during hospitalisation and posthospitalisation. Secondary outcome measures were yield of investigations, diagnoses made, treatments given, social interventions, readmission rate and nosocomial infection. RESULTS: Median age of the 55 children was 15.1 months. Median weight change was 1.5 g day(-1)prior to hospitalisation, 36.7 g day(-1)during and 9 g day(-1)two months following hospitalisation (P < 0.05). Investigations performed had high yields (80% of children had a treatable organic contributor to malnutrition). Nosocomial infection occurred in 21 (38%) children. Readmission occurred at an average of 1.9 times per child (range 0-5), 34 (37%) occurred within three months and 48 (52%) within six months. CONCLUSION: In rural Indigenous children with malnutrition, hospitalisation was effective in re-establishing growth and defining organic contributors to malnutrition. However, the high readmission rate and nosocomial infection mandates that alternative models to nutritional rehabilitation, in addition to a broad psychosocial and public health approach to prevention and management of malnutrition, is required.     

慢性肾脏病患者蛋白质-能量营养不良研究进展

尽管临床治疗水平和透析技术不断提高,但慢性肾脏病(CKD)患者营养不良的发生率仍然逐年上升。近年来,透析前和透析阶段的CKD患者营养目标领域取得一些进展。在透析前阶段,充足的证据显示限制蛋白摄入的长期营养治疗方案可有效纠正蛋白尿、酸中毒等多种代谢异常。维持性透析阶段,现有的蛋白质能量摄入的目标逐渐受到质疑。新颁布的CKD患者蛋白质-能量消耗的诊断标准将有助于医生更轻易地识别早期的蛋白质能量消耗。