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PubMed2003

Nutrition and anabolic agents in burned patients.

PURPOSE OF REVIEW: Much of the morbidity and mortality of severely burned patients is connected with hypermetabolism and catabolism with its accompanying impairment of wound healing and increased infection risks. In order to prevent the erosion of body mass, nutritional support and other strategies to prevent catabolism have become a major focus in the care of severely burned patients. RECENT FINDINGS: Major themes discussed in recent literature are dealing with enteral versus parenteral nutrition and gastric versus duodenal feeding. The possibility of overfeeding is another important aspect of high calorie nutrition as commonly used in burned patients. Specific formulas for enteral nutrition for specific metabolic abnormalities are under evaluation as well as the role of anabolic and anticatabolic agents. SUMMARY: From the clinical literature, total enteral nutrition starting as early as possible without any supplemental parenteral nutrition is the preferred feeding method for burned patients. Using a duodenal approach, especially in the early postburn phase, seems to be superior to gastric feeding. Administration of high calorie total enteral nutrition in any later septic phase should be critically reviewed due to possible impairment of splanchnic oxygen balance. Therefore, measurement of CO(2)-gap should be considered as a monitoring method during small bowel nutrition. The impact on the course of disease of supplements such as arginine, glutamine and vitamins as well as the impact of the use of anabolic and anticatabolic agents is not yet evident. Furthermore, the effect of insulin administration and low blood sugar regimes on wound healing and outcome in burned patients should be evaluated in future studies.

Anabolic Agents↗

PubMed2004

Effects of non-nutritive sucking on nutritive sucking, breathing, and behavior during bottle feedings of preterm infants.

PURPOSE: The purpose of this study was to examine the effect of prefeeding non-nutritive sucking (NNS) on breathing, nutritive sucking (NS), and behavioral characteristics of bottle feeding. SUBJECTS: The convenience sample was composed of 10 preterm infants who were 33 to 40 weeks postconceptual age (PCA) at the time of the observation. DESIGN: Randomized, crossover; each infant was observed twice during the first 48 hours of bottle feeding. METHODS: Ten preterm infants received NNS before 1 bottle feeding and served as their own control at a second bottle feeding. Sucking was measured using a chin strain gauge and breathing was measured with a nasal thermistor. Behavioral characteristics included behavior state, measured using the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) behavior state scale, and feeding efficiency. MAIN OUTCOME MEASURES: Characteristics of NS (number of suck bursts, sucks/burst, suck burst length) and breathing (number of breath bursts, breaths/burst, breath burst length), as well as behavior state during bottle feedings and feeding efficiency (percent of prescribed formula consumed, formula consumed/minute of feeding). PRINCIPAL RESULTS: NS waves were smoother and more regular than NNS waves. Time to onset and duration of the first non-nutritive suck burst were positively correlated with time to onset for the first nutritive suck burst. Prefeeding NNS had no statistically significant effect on characteristics of breathing or on any other characteristics of NS. Behavioral state during feedings and feeding efficiency were not affected by prefeeding NNS. CONCLUSIONS: In this sample, the use of prefeeding NNS did not affect NS, breathing during feeding, or select behavioral characteristics of feeding.

Bottle Feeding↗

PubMed2000

Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes.

OBJECTIVE: Current recommendations for infant feeding encourage breast-feeding through the first year. This research was conducted to evaluate associations among breast-feeding, maternal control of child feeding, and the dietary intake of toddlers during the second year of life. In particular, we sought to determine whether breast-feeding through the first year and subsequent toddler intake was mediated via maternal control of child feeding. DESIGN/SUBJECTS: Fifty-five white infants and their mothers were monitored longitudinally from age 12 or 13 months to age 18 months. MAIN OUTCOME MEASURES: Breast-feeding through the first year and maternal control in infant feeding were evaluated as predictors of energy intake at age 18 months. STATISTICAL ANALYSES PERFORMED: Regression analysis was used to evaluate predictors of toddler energy intake at age 18 months. A mediation model tested if the relationship between breast-feeding and infant intake was mediated by maternal control in feeding. RESULTS: Breast-feeding through the first year was associated with higher toddler energy intakes at age 18 months through its influence on maternal control in feeding. Mothers who breast-fed their infants for at least 12 months used lower levels of control in feeding. Lower levels of maternal control in feeding were associated with higher toddler energy intakes. The highest energy intakes among children aged 18 months were observed among taller and leaner toddlers. APPLICATIONS/CONCLUSIONS: Our findings suggest that breast-feeding through the first year may have an effect on children's energy intake by shaping mothers' child-feeding practices. These findings may be used by clinicians to assist parents in making informed decisions about choice of infant-feeding method and to provide anticipatory guidance regarding infant-feeding style when initiating dietary diversity.

Adult↗

PubMed2004

Continuous nasogastric tube feeding: monitoring by combined use of refractometry and traditional gastric residual volumes.

BACKGROUND & AIMS: Traditional use of gastric residual volumes (GRVs) is insensitive and cannot distinguish retained enteral formula from the large volume of endogenous secretions. We designed this prospective study to determine whether refractometry and Brix value (BV) measurements could be used to monitor gastric emptying and tolerance in patients receiving continuous enteral feeding. METHODS: Thirty-six patients on continuous nasogastric tube feeding were divided into two groups; patients with lower GRVs (<75 ml) in Group 1, patients with higher GRVs (>75 ml) in Group 2. Upon entry, all gastric contents were aspirated, the volume was recorded (Asp GRV), BV measurements were made by refractometry, and then the contents were reinstilled but diluted with 30 ml additional water. Finally, a small amount was reaspirated and repeat BV measurements were made. Three hours later, the entire procedure was repeated a second time. The BV ratio, calculated (Cal) GRV, and volume of formula remaining were calculated by derived equations. RESULTS: Mean BV ratios were significantly higher for those patients in Group 2 compared to those in Group 1. All but one of the 22 patients (95%) in Group 1 had a volume of formula remaining in the stomach estimated on both measurements to be less than the hourly infusion rate (all these patients had BV ratios <70%). In contrast, six of the 14 patients in Group 2 (43%) on both measurements were estimated to have volumes of formula remaining that were greater than the hourly infusion rate (all these patients had BV ratios >70%). Three of the Group 2 patients (21%) whose initial measurement showed evidence for retention of formula, improved on repeat follow-up measurement assuring adequate gastric emptying. The remaining five patients from Group 2 (35%) had a volume of formula remaining that was less than the hourly infusion rate on both measurements. The pattern of Asp GRVs and serial pre- and post-dilution BVs failed to differentiate these patients in Group 2 with potential emptying problems from those with sufficient gastric emptying. CONCLUSIONS: Refractometry and measurement of the BV may improve the clinical utilization of GRVs, by its ability to identify the component of formula within gastric contents and track changes in that component related to gastric emptying.

Enteral Nutrition↗

PubMed2000

Clinical experience in enteral nutrition support for premature infants with bronchopulmonary dysplasia.

OBJECTIVE: The comprehensive management of infants with bronchopulmonary dysplasia (BPD) may include the need for fluid restriction. Modular nutrient components added to preterm formulas increase energy and protein contents but may compromise the nutrient integrity of the formula. The purpose of this pilot study was to compare the nutritional status and feeding tolerance of infants fed either a 30 kcal/oz ready-to-feed formula or a preterm formula containing nutrient supplements. METHODS: Feeding tolerance, growth, and biochemical indicators of nutritional status were compared in 27 premature infants with BPD who were fluid-restricted. These infants were fed either a 30 kcal/oz ready-to-feed formula or a preterm formula with additives concentrated to 30 kcal/oz. RESULTS: Growth and feeding tolerance were similar between groups. Serum albumin and blood urea nitrogen concentrations, however, were improved in the ready-to-feed formula group. CONCLUSION: A 30 kcal/oz ready-to-feed formula provides similar nutrient composition but improved protein nutritional status; this formula is a safe alternative to preterm formula containing multiple nutrient additives in premature infants with BPD.

Bronchopulmonary Dysplasia↗

PubMed2004

The cost of infant feeding in Liverpool, England.

OBJECTIVE: To investigate feeding practices in infants under the age of 4 months in Liverpool, England with particular reference to the cost of infant feeding. DESIGN: A cross-sectional survey consisting of self-completion questionnaires and interviews. SETTING: Subjects' homes within Central and South Liverpool Primary Care Trust areas. SUBJECTS: One hundred and forty-nine women (aged 18 to 43 years) and their infants (mean age 13 weeks). RESULTS: The average weekly cost of breast-feeding was 11.58 pounds sterling compared with 9.60 pounds sterling for formula-feeding. Many breast- and formula-feeding women spent money however on items that were not needed or used only once or twice. This was especially true of first-time mothers. Characteristics significantly associated with higher spending were: feeding method - mothers that had or were partially breast-feeding (P=0.001), education - those educated to degree level (P=0.028), socio-economic status - those in social classes I and II (P=0.002) and age - those aged 30 years and over (P=0.003). CONCLUSIONS: This study demonstrates that while breast-feeding is often promoted as being free, this is not the case. Better information needs to be given to parents to avoid wasting money on items that are unnecessary, or where cheaper alternatives are available.

Adolescent↗

PubMed2001

Migrating motility complexes persist after severe traumatic shock in patients who tolerate enteral nutrition.

BACKGROUND: Postinjury small bowel ileus is poorly characterized and may be an important factor in intolerance to enteral nutrition (EN). We, therefore, placed jejunal manometry catheters in high-risk trauma patients. Our hypothesis was that the presence of "fasting migrating motility complex (MMC)" activity and conversion to a "fed pattern" at goal rate of EN would be present in those patients who tolerate jejunal feeding. METHODS: After obtaining baseline fasting manometry pressure tracings, jejunal feeding was advanced stepwise to a set goal while tolerance was monitored and intolerance was treated by a standard approach. RESULTS: Of the 10 study patients, 7 were able to be maintained on EN. Five (50%) had "fasting MMCs" and had good tolerance to early advancement of EN. The remaining five patients did not exhibit "fasting MMCs" and four had poor tolerance to early advancement of EN. Overall, nine patients reached goal rate of EN of which four converted to a "fed pattern." This, however, was not associated with later tolerance to EN. CONCLUSION: EN is feasible following severe traumatic shock. Surprisingly, half of the patients had fasting MMCs. This requires intact neural and motor function and was associated with good tolerance of early EN.

Adolescent↗

PubMed2004

Antroduodenal motility in neurologically handicapped children with feeding intolerance.

BACKGROUND: Dysphagia and feeding intolerance are common in neurologically handicapped children. The aim is to determine the etiologies of feeding intolerance in neurologically handicapped children who are intolerant of tube feedings. METHODS: Eighteen neurologically handicapped children, followed in the Tube Feeding Clinic at the Children's Hospital of Wisconsin who were intolerant of gastrostomy feedings. The charts of these 18 patients were reviewed. Past medical history, diagnoses, history of fundoplication and results of various tests of gastrointestinal function including barium contrast radiography, endoscopy and antroduodenal manometry were documented. RESULTS: Five of 11 children had abnormal barium upper gastrointestinal series. Seven of 14 had abnormal liquid phase gastric emptying tests. Two of 16 had esophagitis on endoscopy. All 18 children had abnormal antroduodenal motility. CONCLUSIONS: In neurologically handicapped children foregut dysmotility may be more common than is generally recognized and can explain many of the upper gastrointestinal symptoms in neurologically handicapped children.

Adolescent↗

PubMed1982

Influence of cultural and environmental factors on breast-feeding.

A study was undertaken at hôpital Sainte-Justine, Montreal, to determine the factors that influence the choice of feeding method for infants and the duration of breast-feeding. The factors that most clearly distinguished the mothers who breast-fed were lifestyle, education and conditioning to the parental role; those who nursed successfully for a long time were well motivated, well educated, supported by their family, especially the husband, and the La Leche League, and were of an economic status such that it was not necessary for them to return to work soon after delivery. Although the breast-fed babies were more fussy, they were healthier and received fewer drugs.

Bottle Feeding↗

PubMed1985

Lack of long-term effect of the method of infant feeding on growth.

Although we have found that, at 7 years of age, children who were exclusively breast-fed in the first 3 months of life are significantly taller and slightly heavier than those exclusively formula-fed, correction for a variety of other familial factors can explain most of the differences. The breast-fed were longer at birth, had taller mothers, and came from families of higher socioeconomic status, although the last appears to act via maternal stature. There was no difference between the groups at age 7 in skeletal maturity, nor in fatness as measured by combined triceps plus subscapular fatfold. Apparent associations between the method of infant feeding and findings in later childhood must thus be interpreted with caution, since they may reflect differences between the characteristics of families choosing different methods of feeding rather than an effect of the feeding method itself.

Body Height↗

PubMed1984

Factors influencing the feeding of first-born infants.

Influences on the choice and use of an infant feeding method by primigravidae were studied from late pregnancy until six months after delivery. Data were collected by home interviews and postal questionnaires, and from hospital case-notes. Three-quarters of the women had chosen a method before their first hospital visit and most adhered to their choice. Mothers named midwives and health visitors more often than other health professionals as appropriate for discussions about feeding. However, there was little evidence of the influence of health professionals apart from an association between hospital feeding practices and duration of breast feeding. The major influences on mothers were socio-cultural. Findings suggest that breast feeding can be encouraged by a wide dissemination of information, by enabling mothers to discuss feeding with their preferred professional, by respecting an early choice of method, and by encouraging demand feeding which should begin soon after delivery.

Attitude↗

PubMed1999

A controlled trial of alternative methods of oral feeding in neonates.

BACKGROUND: Some neonatal units are introducing use of cup and traditional feeding devices for feeding young infants although they have been not been evaluated objectively. Hence this controlled trial of the use of the bottle, cup and a traditional feeding device ('paladai') was undertaken in neonates. METHOD: The study comprised of 100 infants including full-term normal weight infants (n = 66), term growth retarded infants (n = 20), and preterm infants (n = 14). All three methods were tried on every infant by the same nurse for a particular baby, so that each infant served as his/her control and in order to avoid the effect of major influencing factors. Parameters evaluated were the volume ingested, duration of the feed, degree of spilling and satiety. RESULTS: The infants took the maximum volume in the least time and kept quiet longest with the paladai. The findings were particularly significant in the group including all the categories of infants. Spilling was the highest with the cup, especially with preterm infants.

Feeding Methods↗

PubMed1985

The relationship of breast feeding to third-day bilirubin levels.

The purpose of this study was to determine the relationship of feeding method to serum bilirubin levels on the third day of life. Two hundred eighty-one apparently healthy full-term neonates had third-day bilirubin levels drawn between 58 and 82 hours of age. Mean serum bilirubin levels were 5.6 mg/dL for formula-fed, 6.9 mg/dL for mixed-fed, and 7.5 mg/dL for breast-fed infants. The difference was statistically significant (P less than .01) between the formula-fed and breast-fed groups. Breast-fed infants lost more weight by the third day than formula-fed infants (mean weight loss 180 g for breast-fed infants, 100 g for formula-fed infants). A third-day bilirubin levels among the feeding groups were then compared using an analysis of covariance with weight loss as the covariate. By this method, type of feeding was still a significant predictor of third-day bilirubin levels (P = .04) as was weight loss (P = .03).

Adult↗

PubMed2000

Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia.

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) feeding has been validated in specific clinical situations such as acute stroke with dysphagia and oropharyngeal malignancy. The perception that gastrostomy insertion is safe and technically simple has led to an increase in the demands for PEG insertion, encompassing clinical applications such as in patients with dementia, in whom its role has not been justified. The purpose of this study was to compare the mortality of patients with dementia who were fed by PEG to that of other subgroups of patients requiring gastrostomy feeding. METHODS: The study focused on a cohort of 361 consecutive patients requiring PEG feeding between August 1992 and July 1997 from two District General Hospitals (Rotherham District General Hospital and Doncaster Royal Infirmary) in South Yorkshire. A retrospective cohort survival analysis was performed using the Kaplan-Meier survival method and Cox proportional hazards analysis. RESULTS: In all patients requiring gastrostomy feeding there is a high initial mortality of 28% at 30 days. However, patients with dementia have a worse prognosis compared to other subgroups, with 54% having died at 1 month and 90% at 1 yr (log rank test p < 0.0001). This difference remained significant (log rank p < 0.0001) after adjusting for age at the time of PEG insertion. CONCLUSIONS: This is the first demonstration in the United Kingdom that the mortality of patients with dementia who are fed by gastrostomy is considerable. Consequently, we may wish to advise against gastrostomy feeding in selected patients within this clinical setting.

Aged↗

PubMed2001

Influence of breast-feeding on the production of cytokines.

PROBLEM: Recently, we reported increases in the production of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), and IL-4 during the postpartum period. The present study was undertaken to investigate whether these increases might be explained by increased prolactin while breast-feeding. METHOD: Whole blood from 41 women who were breast-feeding, 13 women not breast-feeding, and 31 healthy non-pregnant women was stimulated with phorbol 12-myristate 13-acetate and ionomycin, and the levels of cytokines in the supernatant were measured by enzyme-linked immunosorbent assay. Their serum levels of prolactin were measured by enzyme immunoassay. RESULTS: Increases in IFN-gamma, IL-2, IL-4, and IL-10 production were observed in women who were breast-feeding but not in women who were not breast-feeding. Serum levels of prolactin correlated with the levels of IFN-gamma in culture supernatant. CONCLUSIONS: These results suggest that breast-feeding induces production of cytokines and that IFN-gamma production is enhanced by physiological concentrations of prolactin.

Breast Feeding↗

PubMedDate not supplied

Breastfeeding knowledge, breastfeeding confidence, and infant feeding plans: effects on actual feeding practices.

OBJECTIVE: To explore relationships among breastfeeding knowledge, breastfeeding confidence, and infant feeding plans and their effects on feeding practices in first-time breastfeeding mothers. DESIGN: Prospective descriptive design. SETTING: Telephone interviews were conducted prenatally and at 6 weeks, 3 months, and 6 months postpartum. PARTICIPANTS: Seventy-four of 83 first-time mothers with prenatal intentions to breastfeed completed all study requirements. The majority were White (95%), between the ages of 21 and 30 years (73%), with a post-high school education (85%), and household incomes of more than 200% of the federal poverty guideline (88%). MAIN OUTCOME MEASURES: Breastfeeding knowledge, breastfeeding confidence, planned infant feeding method, planned breastfeeding duration, weeks of daily human milk substitute feeding, breastfeeding duration, achievement of breastfeeding goals. RESULTS: Breastfeeding knowledge was strongly correlated with breastfeeding confidence (r = .262; p = .025) and actual lactation duration (r = .455; p = .0001). Compared with women planning to exclusively breastfeed their infants, those planning to combination feed planned shorter breastfeeding duration (p = .022), reported shorter actual duration (p = .004), and were less likely to meet their breastfeeding goal (p = .034). The variables maternal education, breastfeeding knowledge, and weeks of daily human milk substitute feeding were used to develop a prediction equation that correctly categorized 93% of participants who met their breastfeeding goal and 90% of those who did not. CONCLUSIONS: Expectations and the actual breastfeeding experience differed among women planning to combination feed and those planning to exclusively breastfeed. Whether a cause or consequence, daily human milk substitute feeding was associated with negative breastfeeding outcomes.

Adult↗

PubMed1986

Nutrition guidelines for burned patients.

Among all hospitalized patients, burned patients have been shown to have the greatest increase in metabolic demand. However, the temptation to overfeed those patients must be recognized, as that practice may lead to increased morbidity. Care must be taken to provide an appropriate nutritional regimen in order to minimize protein catabolism and to promote wound healing. Several formulas for calculating energy and protein needs for burned patients have been reviewed for this article, along with guidelines for estimating other nutrients for such patients. Methods for providing nutrition therapy depend on many factors, such as extent and degree of injury and gastrointestinal function. The feeding methods most commonly used are parenteral (peripheral and central venous alimentation) and enteral (oral and naso-gastric tube feeding). Guidelines for using both parenteral and enteral feedings are discussed, as well as reliable methods for evaluating the nutrition assessment of the burned patient. It must be noted that standard assessment parameters are often unreliable, and their limitations are also addressed. In addition, several new parameters are introduced, including compliance with caloric goal, corrected weight change, and prediction of total urinary nitrogen to be used to calculate nitrogen balance.

Anthropometry↗

PubMed1993

Breast-feeding counseling practices of family practice residents.

BACKGROUND: Despite breast-feeding being the best newborn feeding method, the percentage of women in the United States who breast-feed has declined. Family physicians are in a unique position to counsel women about breast-feeding because their emphasis on continuity of care provides both prenatal and postnatal contact. Whether family physicians are trained sufficiently to offer such counseling is unknown. METHODS: A pretested questionnaire was distributed to all residents in 11 of 14 residency programs in North Carolina and Georgia. Data were analyzed with descriptive chi-square statistics and backward logistic regression to assess variables independently predictive of residents' counseling behaviors. RESULTS: One hundred fifty-five residents filled out usable surveys (response rate: 69%). The residents' primary teachers of breast-feeding were family physicians (34%) and nurses (33%). Most residents (93%) felt it was their personal responsibility to counsel women about breast-feeding; 67% believed their training was inadequate, and 48% stated they lacked necessary skills. Forty-one percent of residents counseled such women less than 50% of the time. Personal or spousal breast-feeding experiences gave residents more confidence in breast-feeding anticipatory guidance (P < .001), comfort in teaching techniques (P < .001), and effectiveness in counseling (P < .009) but did not lead to improved counseling rates. Multivariate analysis showed that female residents, those with high confidence in their breast-feeding counseling skills, and residents that had adequate training in breast-feeding counseling instructed women more often about breast-feeding. CONCLUSIONS: Breast-feeding counseling skills are an important but neglected aspect of family practice clinical training. Personal breast-feeding experience is an important indicator of breast-feeding counseling confidence and effectiveness, although it doesn't ensure that proper counseling skills are obtained. Family medicine training programs should incorporate breast-feeding educational programs into their residency curricula.

Breast Feeding↗