A systematic review of enteral feeding by nasogastric tube in young people with eating disorders

Abstract

Background Adolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment. Nasogastric feeding (NG) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement poor oral intake or to increase nutritional intake. This systematic review sets out to describe current practice of NG in young people with eating disorders. Methods A systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000 to 2020. Inclusion terms were: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: psychiatric disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and participants over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles. Quality assessment, including risk of bias, was conducted by all authors. Results Twenty-nine studies met the full criteria. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) a wide range of refeeding regimes depending on country, settings, and the reason for initiation; 2) standard practice is to introduce Nasogastric feeds (NG) if medically unstable or oral intake alone is inadequate; 3) NG may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 6) where NG is routinely implemented to increase total calorie intake, length of stay in hospital may be reduced; however where NG is implemented in correlation to severity of symptoms, it may be increased; 7) both medical and psychiatric wards most commonly report using NG in addition to oral intake. Conclusions NG feeding is a safe and efficacious method of increasing total calorie intake by either supplementing oral intake or continuously. There are currently no direct comparisons between continuous, nocturnal or bolus regimes, which may be used to direct future treatment for YP with ED.

Early Naso-Gastric Feeding and Outcomes of Anorexia Nervosa Patients

“…In contrast to our results, some researchers have found a shorter LOS in NGF-treated patients [ 21 , 22 , 23 , 24 , 25 ]. In particular, one study showed that OF requires a longer period for weight restoration due to the lower caloric component (50.9 days in cases of OF vs. 33.8 days in cases of NGF) [ 22 ]; Golden et al showed that the LOS was significantly shorter in the NGF group (13.0 ± 7.3 days vs. 16.6 ± 9.0 days; p < 0.0001) [ 23 ]; faster weight restoration was described in a prospective study by Garber et al [ 15 , 24 , 25 ].…”

“…Furthermore, the literature lacks guidance on the most appropriate mode of NGF administration (bolus, overnight regimen or continuous). A direct comparison between these three different regimens has not yet been performed [ 15 ].…”

Nasogastric tube feeding under restraint: practical guidance for children’s nurses

“…Nasogastric tube feeding has been shown to be safe and feasible in young people with an eating disorder who have consented to treatment (Hindley et al 2021). On children's wards, nasogastric tube feeds, which may be used for a range of conditions, are commonly administered enterally either through pump feeding or gravity feeding.…”

The effect of oral refeeding compared with nasogastric refeeding on the quality of care for patients hospitalised with an eating disorder: A systematic review

“…Nasogastric refeeding, otherwise referred to as enteral feeding, has been suggested as a lifesaving treatment when patients are physically unwell. 6 Nasogastric feeding involves insertion of a fine bore tube being passed via the nasal passage and into the stomach to provide nutrition. 7 Provision of nasogastric feeding can be delivered in different ways, either as a large bolus via gravity feeding or via a pump, continuously over a 24‐h period via a pump or provided intermittently overnight to supplement daytime oral intake.…”

“…7 Provision of nasogastric feeding can be delivered in different ways, either as a large bolus via gravity feeding or via a pump, continuously over a 24‐h period via a pump or provided intermittently overnight to supplement daytime oral intake. 6 Oral refeeding, otherwise known as meal‐based feeding, is where energy intake is provided via oral intake alone without the use of a nasogastric tube.…”