Exploring Clinical Outcomes and Feasibility of Blended Tube Feeds in Children

Abstract

Commercially produced complete nutritional formulas (CFs) are commonly delivered to children requiring enteral nutrition via gastrostomy. However, a cultural shift toward consuming a more natural diet consisting of whole foods has caused the use of blenderized tube feeds (BTFs) to grow in popularity among parents and carers in recent years. There are advantages and disadvantages of both BTF and CF use. There is evidence that suggests that BTFs can significantly improve tube-feeding tolerance and reduce gastrointestinal symptoms associated with tube feeding, such as gagging, retching, and constipation, thereby resulting in an improved quality of life (QoL) for enterally fed children and their caregivers. BTFs have also been implicated in increasing the diversity of the gut microbiota in enterally fed children. However, concerns have been raised that BTFs may be inferior to CFs in energy and nutrition sufficiency. Issues such as microbial contamination, tube blockages, and difficulties in preparation and administration may also complicate the use of BTFs. Additionally, like CFs, BTFs can vary significantly in nutrition composition, and dietitian involvement with BTF use is crucial. The current literature on the clinical outcomes of BTF use is limited, and further research is needed before recommendations can be made on BTF use in children. A literature review was conducted to compare clinical outcomes between BTFs and CFs and evaluate the feasibility of BTF use in children.

Monitor gastrointestinal tolerance in children who have switched to an “enteral formula with food‐derived ingredients”: A national, multicenter retrospective chart review (RICIMIX study)

“…However, blended diets may not be suitable for intensive care or other acute clinical settings because of the perceived risk of microbial contamination and the variability in micronutrients and electrolytes. 8 Therefore, having an alternative, such as a complete "enteral formula with food-derived ingredients," may serve as a compromise to a blended diet, bridging the gap between a full blended diet and a standard enteral formula, thus facilitating relationships and engagement between parents and healthcare professionals. However, as Chandrasekar et al correctly point out, there is limited evidence that blended diets can significantly reduce gastrointestinal symptoms associated with tube feeding and improve aspects of quality of life.…”

“…However, as Chandrasekar et al correctly point out, there is limited evidence that blended diets can significantly reduce gastrointestinal symptoms associated with tube feeding and improve aspects of quality of life. More research is needed to evaluate whether blended diets and “enteral tube feed containing food‐derived ingredients” support growth in children and to explore potential complications 8 . Of note, one child in this study discontinued the new formula because of an undiagnosed allergy‐related disorder and, therefore, it is advisable that any children who have not been exposed to whole food since being exclusively tube fed should be carefully monitored and may require further input from the allergy team.…”

“…It is perceived to be more natural and better tolerated compared with commercially available standard enteral formulas 7 . Previous studies have reported positive clinical outcomes with the use of blended diets, including reduced gagging, retching, and vomiting compared with commercially available standard enteral formulas 7,8 . In 2020, the British Dietetic Association amended its guidelines to enable dietitians in the United Kingdom to support a blended diet for tube‐fed individuals and to encourage an open, multidisciplinary approach to administering blended diets via a feeding tube (British Dietetic Association Policy Statement 9 ).…”

Feeding children with neurodisability: challenges and practicalities

“…For some children to achieve this, adaptation to seating and positioning will be required, along with texture modification and food fortification 8. Food (feed) consumed orally is the most physiological and best tolerated route of feeding, providing a variety of foods promoting healthy gut microbiome 25. In certain situations where it is either not safe, takes a lot of time and effort or enough food cannot be tolerated because of poor feed tolerance, the options could be feeding intragastrically via a nasogastric tube or a more permanent gastrostomy.…”

Dysbiosis in Children With Neurological Impairment and Long-Term Enteral Nutrition

“…The reduction of Proteobacteria in the feces showed the benefit of BEN in preserving a healthy gut microbiota (19). Although increased gut microbial diversity may improve gastrointestinal mobility, the use of BEN still raises concerns and is not currently the first choice (13,14,20).…”