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Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults.

Introduction Telephone interviews with parents were conducted as part of a hospital-wide, multi-professional pilot project to introduce naso-gastric tube (NGT) feeding at home for babies with feeding difficulties due to bronchiolitis, with the aims of improving parent experience, shortening length of stay in hospital and empowering parents to participate in their child’s care. Method We identified 42 patients who met our inclusion criteria of being admitted to hospital for NGT feeding due to bronchiolitis from September 2017 – March 2018. A survey letter to parents explained the project intentions, reason for the interviews and an option to opt out. The interview comprised 5 closed questions, followed by open questions to explore the answers. Questions were targeted at understanding ideas, concerns and expectations of the proposed project, with respect to parents’ previous hospital experience. Key response themes Overall response to the project was positive, with the concept of NGT feeding at home being welcomed by most interviewees. Reasons included being able to care for baby in a relaxed environment with less disruption to daily routine, feeling empowered and reduced risk of exposure to other infections in hospital. 18 interviewees said they would take up the offer to be NGT trained in order to increase the likelihood of early discharge from hospital, provided sufficient training was provided. Negative reasoning included their baby being too young, being first time parents, or previous bad experiences with their baby pulling out the NGT or being very unwell with bronchiolitis. Parents’ mains concerns revolved around points of contact outside weekday hours, especially for accessing trouble-shooting advice (e.g. NGT blockage/dislodgement). Interviewees were asked for views on how they could feel comfortable and supported at home, with the main themes including 24-hour contact (including a pathway for trouble-shooting) and written material. The proposition of training packs to be given as part of the service, covering these matters, was welcomed. All parents were happy to have a member of the community nursing team contact them and/or visit them at home to give advice and support in managing NGT feeds at home. Outcome These responses were shared at the final multi-professional meeting for the project, which included representatives of hospital management. This contributed to approval and progression of the pilot project which ran from October 2018 to March 2019.

Background We previously reported on three preterm infants with blood glucose abnormalities after reaching full enteral feeding. Recently, it has been shown that clinically stable preterm infants may have large fluctuations in blood glucose after the establishment of enteral nutrition. We hypothesized that intraday glucose fluctuation is a common finding in preterm infants, but improves at term post-conceptual age. This report describes a case series. Methods From June 2010 to July 2012, 13 preterm infants (29.5 ± 2.1 post-conceptual weeks, 1144 ± 319 g) were enrolled in this study. Continuous glucose monitoring (CGM) was conducted on average at 33.5 ± 1.4 post-conceptual weeks, when they received gastric tube feeding every 3 h in the absence of i.v. glucose supply. Results Eight infants (62%) had large intraday glucose fluctuation with repeated hyperglycemic (>150 mg/dL) and hypoglycemic (

Objective For many years, the microsurgical transoral approach (TOA) has been accepted as the “gold standard” for the surgical treatment of a variety of congenital, developmental, and acquired pathologies affecting the craniovertebral junction. In the present study, we try to investigate both experimental and clinical fronts of such a challenging surgery, starting from the updated literature experience. TOA is actually presented as an “old-fashioned” surgical technique dealing with possible bacterial contamination, the need of postoperative nose gastric tube feeding for a week, the possible nasopharyngeal incompetence, and the postoperative tongue swelling. Otherwise, the endoscopic endonasal approach (EEA) appears strongly supported by the modern literature as the true “minimally invasive” procedure. Methods Our clinical experience deals with 23 anterior procedures in paediatric and adult patients (17 TOA and 6 EEA). We further report on our experimental cadaver laboratory study of 12 subjects. Results All the patients of TOA group but one were discharged after posterior procedures within two weeks and improved or remained unchanged after surgery and during the follow-up. No mayor complications occurred in TOA group. In EEA group two patients died for cerebrospinal fluid infection, for disease progression and for heart attack. Conclusion Our and other available data suggest that no clear superiority of EEA over endoscopic TOA can be assessed so far; on the other hand, EEA can produce complications similar to TOA in craniovertebral junction surgery.

This article discusses the potential benefits of early discharge home from the neonatal unit, with a naso-gastric tube in situ, to establish oral feeding at home. It describes a programme that has been implemented to promote this and the initial outcomes and experiences.

Late-onset hypoglycemia (day 12-16, blood glucose

BACKGROUND: Poor hospital outcomes among adult patients admitted to hospitals have been attributed to inadequate nutrient intake and progressive disease conditions. The purpose of this study was to determine the adequacy of the intake of energy, zinc and selenium among adult inpatients receiving hospital prepared total naso-gastric blended tube feeding (NGTF). METHODS: This was a cross-sectional study that adopted quantitative approaches in data collection, analysis and presentation. A comprehensive sample of 113 adult patients, 20–65 years of age who had been on total NGTF in the previous 24 h participated in the study. Nutrient adequacy for individual patients was established using the Harris Benedict equation (HBE) and the European Society for Clinical Nutrition and Metabolism (ESPEN) daily recommendations for zinc and selenium intakes. A researcher-administered questionnaire was used to collect data on socio-economic and medical characteristics. Fourteen pairs of hospital prepared NGTFs were sampled weekly for 3 months and analysed for total energy, carbohydrate, protein, fat, zinc and selenium content using AOAC international methods. RESULTS: Mean total energy, zinc and selenium content for NGTF was 126.9 ± 67.0 Cal/100 ml (64.6 % carbohydrate, 23.1 % protein and 12.3 % fat), 0.13 ± 0.01 mg/100 ml and 0.09 ± 0.02 μg/100 ml respectively and this content varied significantly among the paired samples (p

Naso gastric tube feeding (is also known as enteral nutrition) given to meet the nutritional requirements when oral intake is inadequate or not possible as long as gastro intestinal tract is not functioning properly. This study aimed to assess the knowledge and skills regarding nasogastric tube feeding among staff nurses working in selected hospitals of district Mohali, Punjab. A quantitative research approach with descriptive research design was adopted for the study.100 staff nurses were selected through convenient sampling technique. Study showed that majority of staff nurses were having average knowledge (54%) and fair practices (58%) regarding nasogastric tube feeding. There was no significant association with age, gender, educational qualification, total work experience, present area of work, duration of work in the present area and in-service education program attended related to nasogastric tube feeding at p< 0.05.

Objective: To study the effect of sufficient energy intake, by means of the protocolized administration of naso-gastric tube feeding, on the nutritional status of a child with cancer. Design: A comparative experimental study. Setting: Tertiary care at the Centre for Pediatric Oncology, South East Netherlands, University Hospital, Nijmegen. Subjects: Seven children, newly diagnosed with cancer, were included in the experimental study and all completed the trial period. Fourteen patients were included in the retrospective study. They were randomly chosen from a group of patients previously treated for a malignancy at our department and who had received naso-gastric tube feeding for at least 16 weeks. Intervention: Protocolized (experimental group) vs non-protocolized (retrospective group) administration of naso-gastric tube feeding over a period of 16 weeks. The main difference was the amount of tube feeding administered. In addition to energy from other foods, children in the experimental group received 106±13% of their total daily energy requirements (TDER) by means of tube feeding, whereas children in the retrospective group had received 75±24%. Main outcome measures: Weight as a percentage of weight for height according to the 50th percentile of a healthy reference population=ideal weight. Results: Weight, expressed as a percentage of the ideal weight, increased significantly in the experimental group (18.2±8.4; P=0.01) and the retrospective study group (5.2±7.3; P=0.001). However, the increase was statistically significant in favour of the experimental group (P=0.003), in which all the children reached their ideal weight, compared to 21% in the retrospective group. Conclusion: Aggressive protocolized nutritional intervention during the intensive phase of anti-cancer treatment, in the form of naso-gastric tube feeding that provides the child’s total daily energy requirements, results in considerable improvement in the nutritional status.

The American Academy of Pediatrics recommends intravenous fluids for infants with bronchiolitis who are unable to sustain oral feedings. Our randomized, prospective pilot study shows that gastric tube feeding (in 31 infants) is feasible and demonstrated comparable clinical outcomes with intravenous fluids (in 20 infants) among hospitalized infants ≤6 months of age with moderate bronchiolitis.

Given that, in most clinical circumstances, enteral nutrition (nasal gastric tube feeding) may not necessarily be superior to parenteral nutrition (IV feeding), consideration of patient preference should be included in decisions on the method of feeding.To evaluate patient preference for nasal gastric versus IV feeding.We administered a written questionnaire to 101 hospitalized oncology patients and 98 outpatients without gastrointestinal illness (controls). Statistical analyses included comparisons of group means with Student t tests, comparisons of proportions with chi2 tests, and logistic regression analysis.Demographic variables of the 2 groups were comparable. In both groups, most individuals preferred IV to tube feeding. Preference for IV or tube feeding was related to patient perception of the comfort of these interventions. In logistic regression analyses, the strongest influences on preference were age and perceived comfort of IV feeding. Older individuals preferred IV to tube feeding. Gender, education level, physician's recommendation, and cost did not influence patient preference.Most patients prefer IV to nasal gastric feeding. Awareness of this patient preference is helpful in making decisions regarding the method of nutrient delivery.

Male Sprague-Dawley rats (125 g) were fed by gastric tube either a zinc-deficient or a zinc-adequate diet for 32 days. In an additional study, rats were administered similar diets per os. Growth rate, zinc levels in plasma and tissues, and selected enzyme activities were measured. In tube fed rats receiving 13.5 g/day of a zinc-deficient diet, growth rates were similar to controls for 25 days but were somewhat lower by 32 days. The mean food intake of the rats fed the zinc-deficient diet per os was 7.6 +/- 2.1 g/day, and on day 25 growth rate was significantly lower than pair-fed and ad libitum-fed controls. Zinc levels of plasma and tissues and delta-aminolaevulinic acid dehydratase (ALAD) activity in erythrocytes and liver were reduced in rats fed the zinc-deficient diet in both studies. Alkaline ribonuclease activity remained unchanged. The larger nutrient intake provided by gastric tube feeding appears to delay the growth-retarding effect of zinc-deficient diets, but changes in zinc tissue levels and ALAD activity are similar in tube fed and per os fed rats.

Purpose: to compare the weight gain among newborns submitted to the kangaroo method and those not submitted to it, and to analyze the factors that may influence this gain: length of hospital stay, gestational age, corrected gestational age, birth weight, weight on the first day of follow-up, duration of gastric tube feeding, duration of oral feeding, and type of diet. Methods: a cross-sectional, quantitative study, with 86 newborns divided into two groups: group 1, with 48 neonates undergoing skin-to-skin contact and Group 2, 38 newborns who did not have this contact. Weights were recorded until hospital discharge. Results: a greater weight gain in Group 1, a longer time of hospitalization in Group 2, and a significant difference in weight gain related to the type of diet in Group 2. Conclusion: skin-to-skin contact has a positive influence on weight gain and length of hospital stay of newborns. The use of an infant formula does not influence weight gain for dyads who experienced skin-to-skin contact. Gestational age, corrected gestational age, birth weight, weight on the first day of follow-up, duration of gastric tube feeding, duration of oral feeding are not correlated with weight gain. RESUMO Objetivo: comparar o ganho de peso entre recém-nascidos submetidos ao método canguru e os não submetidos e analisar os fatores que possam influenciar nesse ganho: tempo de internação, idade gestacional, idade gestacional corrigida, peso ao nascimento, peso no primeiro dia de acompanhamento, tempo de uso de sonda gástrica, tempo de alimentação por via oral e tipo de dieta. Métodos: trata-se de um estudo transversal, de caráter quantitativo. Participaram 86 neonatos divididos em dois grupos: Grupo 1, com 48 neonatos submetidos ao contato pele a pele, e Grupo 2, com 38 neonatos que não tiveram esse contato. Foram registrados os pesos até o momento da alta hospitalar. Resultados: maior ganho de peso no Grupo 1, maior tempo de internação no Grupo 2; diferença significante no ganho de peso relacionada ao tipo de dieta no Grupo 2. Conclusão: contato pele a pele influencia positivamente no ganho de peso e tempo de internação dos neonatos. Uso de fórmula infantil não influencia o ganho de peso para as díades em contato corporal. Idade gestacional, idade gestacional corrigida, peso ao nascimento, peso no primeiro dia de acompanhamento, tempo de uso de sonda gástrica, tempo de alimentação por via oral não está correlacionado com o ganho peso.

Alpha-linolenic acid deficiency is described in four adults fed by gastric tube. In plasmaand erythrocytes,total lipid 20:3n-9 was slightly increased but total n-6 fatty acids, arachidonic acid, and dihomo-gammalinolenic acid were normal. Total n-3 fatty acids, l8:3n-3, 20:5n-3, 22:5n-3, and 22:6n-3 were decreased in both plasma and erythrocytes. Patients had a slight but definite scaly dermatitis, which disappearedwith essential fatty acids supplementation.Simultaneously, levelsof 18:3n-3, 20:5n-3, 22:5n-3, 22:6n-3, 20:3n-9, and total n-3 fatty acids became normal while l8:2n-6, 20:3n-6, 20:4n-6, and total n-6 acidswere unchangedor slightly lowered.Estimated minimal daily requirement of linolenic acid and of long-chain unsaturated n-3 acidsin adults is �0.2-0.3% and 0.1-0.2%, respectively,of total energyintake. Resultssuggestthat conversionof linolenic acid to 22:6n-3 is increasedin linolenic acid deficiency. Am I Clin Nuir l987;45:66-77.

A case in which passage of a narrow bore naso-gastric tube into and through the right main bronchus and accidental soiling of the lung parenchyma with Clinifeed is reported. The presence of a healing tracheostomy stoma was considered a contributory factor. Suggested means of avoiding such an accident are, air insufflation while auscultating over the epigastrium, chest X-ray before commencing feeding and proper liaison between medical and nursing staff.

Monn, E. (Department of Paediatrics, Rikshospitalet, University of Oslo, Oslo, Norway). Prostaglandin synthetase inhibitors in the treatment of nephrogenic diabetes insipidus. Acta Paediatr Scand, 70:39, 1981.–Two boys with classical ND1 have been treated with prostaglandin synthetase inhibitors. A boy, 7 years old, was treated with low solute-load diet and diuretics from his first year of life. His main complaint was nocturnal enuresis. He responded within one day to indomethacin 25 nig twice daily, and the urine volume was reduced from 4½-6 litre/day to 2½-3 litre/day. There is almost no enuresis. A boy, 7 months old, had a basal daily urine volume of 1.6-1.8 litre. A low solute-load diet and diuretics reduced urine volume to 1 litre, but he still needed gastric tube feeding. With the addition of acetylsalicylic acid, 75 mg three times daily, the urine volume was reduced to 600 ml, and he needed no more tube feeding. Both boys are doing well on the above-mentioned regimens, and no side effects have been observed after 1 year of treatment.