Transition to a Tube Feeding Formula With Real Food Ingredients in Pediatric Patients With Intestinal Failure

Samela, Kate; Mokha, Jasmeet S.; Emerick, Karan; Davidovics, Zev

doi:10.1177/0884533616661011

Cited by 56 publications

(81 citation statements)

References 13 publications

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“…Although the development of constipation has not been reported previously, this symptom was not formally assessed in other studies . Another study noted decreased stool output in children with intestinal failure and diarrhea when they received blended diets . These authors hypothesized that the complexity of whole foods and the increased amount of long‐chain fatty acids contained in the blended diets (compared with standard formulas) may stimulate gut adaptation.…”

Section: Discussionmentioning

confidence: 99%

“…4,9 Another study noted decreased stool output in children with intestinal failure and diarrhea when they received blended diets. 10 These authors hypothesized that the complexity of whole foods and the increased amount of long-chain fatty acids contained in the blended diets (compared with standard formulas) may stimulate gut adaptation. Also highlighted was the suggestion that the variety of fiber types found in a blended diet may alter the gut microbiota, disfavoring dysbiosis and benefiting nutrient absorption and therefore decreasing diarrhea.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy Feeds

et al. 2019

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Background To determine the prevalence of gastrointestinal (GI) symptoms in children receiving a blended diet via a gastrostomy tube. Methods This is a single‐center, retrospective study of children ages 1–18 years that received a blended diet. We reviewed demographics, anthropometrics, clinical characteristics, and rationale for switching to blended diet. Fixed‐effects logistic regression analysis was used to evaluate the changes in patient symptoms over the 12‐month follow‐up period, and fixed‐effects regression was employed to test for changes in anthropometrics. Results Twenty‐three patients (8 female, 15 male) were identified, and data from 89 outpatient visits were analyzed. The most common underlying diagnosis was neurological disorder. Thirty‐five percent of patients received commercial whole cow milk formulas, 30% received hydrolysate formulas, and 35% received amino acid−based formulas. After formula switches were made, 65% received homemade blended diets, 17.5% received commercial blended diets, and 17.5% received a combination of both. Median duration of time on a blended diet was 17 months. Ninety‐five percent of patients who were previously experiencing upper GI symptoms improved within the first 3 months after blended diet initiation. Twenty‐one percent of patients developed mild constipation on the diet, which was managed with increased water intake and/or polyethylene glycol. Only 2 patients discontinued the blended diet, because of inadequate weight gain and worsening of upper GI symptoms. Conclusions In our study population, blended diets were well tolerated in gastrostomy‐fed children and were associated with clinical improvement of upper GI symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy Feeds

et al. 2019

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“…It should be noted that 433 parents of blended‐fed children reported their children had fewer gastrointestinal symptoms with blended feeds than with standard formula and, when these occurred, attributed them to the child's medical condition rather than food‐borne illness associated with feeding . Similarly, improvements in bowel habits associated with receiving blended feeds have been reported . The positive role of microbes in gastrointestinal health needs consideration because these may be contributing to some of the improvements reported by those using or preparing blended feeds.…”

Section: Discussionmentioning

confidence: 99%

A laboratory‐based evaluation of tube blocking and microbial risks associated with one blended enteral feed recipe

Madden

Baines

Bothwell

et al. 2019

J Human Nutrition Diet

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Background Concerns associated with blended enteral feeds include the risk of blocked tubes and microbial contamination, although the available evidence is limited. The present laboratory‐based investigation aimed to examine these risks in a blended feed providing a nutritionally adequate intake for a hypothetical patient. Methods A one‐blended feed recipe was made using three different methods (professional, jug and stick blenders) and three storage procedures. Feed samples were syringed via 10‐, 12‐ and 14‐French (Fr) enteral feeding tubes and both blockages and the time taken were recorded. Feed samples were diluted, plated on agars, incubated and bacterial colony‐forming units (CFU) counted. After storage at −80 °C, identification was undertaken using 16S rRNA polymerase chain reaction sequencing. Results Two blockages occurred during 27 administrations of feed made using a professional blender, although they were resolved with a water flush. No blockages occurred with the 14‐Fr tube and administration was quicker with wider tubes (P < 0.00001). There was no significant difference between the total bacterial CFU of feeds prepared using different methods (P = 0.771) or stored differently. The genus of bacteria identified included Enterococcus, Bacillus, lactose‐fermenting Enterobacteriaceae, Pseudomonas and Staphylococcus. Pathogens, such as Clostridium spp., Salmonella spp. and Vibrio spp., were not identified by phenotypic tests used. Sequencing identified Escherichia coli, Shigella spp., Streptococcus lutetiensis and Staphylococcus epidermidis. Conclusions The present study found no risk of tube blockages when one blended feed recipe made using three methods was delivered via a 14‐Fr tube. There is concern about bacterial contamination, although this was not influenced by the methods of preparation or storage used in the present study.

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“…An investigation of the fibre content of commercial enteral feeds highlighted concerns about mineral retention in fibre used in formula and other effects of formula fibre, including bloating, gas and cramps (26) . More recently, researchers suggested that a blended diet may improve stooling patterns by incorporating complex whole food nutrients and varying types and quantities of fibres and fats (27) . A study investigating the properties of commercial formulas found a lack of the necessary bacteria present in a normal diet that help maintain normal gut function and, in addition, antioxidants and bioflavonoids required for long-term prevention of disease were absent (28) .…”

Section: Nutritional Valuementioning

confidence: 99%