Dietitians' perceptions and experience of blenderised feeds for paediatric tube-feeding

Abstract

Results: Of the 77 respondents, 19 were aware of professional guidelines and 63 had never received training on BFTF. Thirty-four wouldn't recommend BFTF and 11 would advise against its use; yet 43 would recommend it to supplement commercial feeds. Fifty-seven would change their perception about BFTF if there were evidence based guidelines. Fortyfour would feel confident to support a patient using BFTF. Forty-three had previous experience supporting a patient with BFTF. The main concerns perceived by dietitians, pertinent to the use of BFTF, were nutritional inadequacy (n=71), tube blockages (n=64) and increased infection risk (n=59) but these were significantly higher than those experienced by themselves in clinical practice (p<0.001 for all three). A reduction in reflux and vomiting and increased carer involvement were the main perceived and observed benefits by both dietitians and carers.

Comparison of Microbial Growth Between Commercial Formula and Blenderized Food for Tube Feeding

“…Although reasons why BTF ameliorates symptoms of tube feeding intolerance in some individuals have not been elucidated, at least part of the answer might be dietary diversity and subsequent microbiome response to whole food feeding. These early research associations are congruent with anecdotal reports from tube‐fed patients and/or caregivers of tube‐fed patients that BTF reduces gastrointestinal problems compared with CF feeding . Furthermore, BTF may be cost‐effective compared with CF by replacing more expensive elemental formulas and/or gastrointestinal medications.…”

“…In the study by Johnson et al, the most frequently cited reason registered dietitians/nutritionists in pediatric practice did not use BTF was the concern for food‐borne infection . In a similar survey of U.K. dietitians, the top 3 reasons cited for not using BTF were concerns of inadequate nutrition, blocked tubes, and increased risk of infection; however, these concerns were rarely observed among BTF users in clinical practice …”

“…BTF has continued in areas where CF is not widely available, and in limited patient populations in developed countries . However, interest in and use of BTF have recently increased substantially in developed countries and are largely driven by patients and caregivers . This development creates conflict between the desire to provide patient‐centered care and adherence to established healthcare policies.…”

“…Some parents and healthcare providers (HCPs) report BTF supports growth in children, sustains weight in adults, alleviates tube feeding intolerance (constipation, retching, vomiting, gastric pain, etc. ), improves oral intake, and is less expensive than CF . Other research suggests BTF is not adequate to support the complete nutrient needs of patients and carries a high risk of bacterial infection .…”

“…This is particularly worrisome in the pediatric population where nutrient needs change over time, creating potential for nutrient deficiencies that may impact growth . Exacerbating the problem, many HCPs are unaware of the potential benefits of BTF or how to assist their patients who want to explore this feeding option . BTF is not appropriate for all tube‐fed individuals (eg, jejunal feeding), and care must be taken to avoid pitfalls particular to whole food tube feeding …”