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PubMedDate not supplied

Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding.

BACKGROUND: Strategies that maximize the delivery of enteral nutrition while minimizing the associated risks have the potential to improve the outcomes of critically ill patients. By delivering enteral feeds in the small bowel, beyond the pylorus, the frequency of regurgitation and the risk of aspiration is thought to be decreased while at the same time, nutrient delivery is maximized. The purpose of this paper is to systematically review those studies that compare gastric with small bowel feeding. METHODS: We searched computerized bibliographic databases, personal files, and relevant reference lists to identify eligible studies. Only randomized, clinical trials of critically ill patients that compared small bowel and gastric feedings were included in this review. In an independent fashion, relevant data on the methodology and outcomes of primary studies were abstracted in duplicate. RESULTS: There were 10 studies that met the inclusion criteria for this review. In 1 study, small bowel feeding was associated with a reduction in gastroesophageal regurgitation and a trend toward reduced pulmonary aspiration. Several studies document that small bowel feeding was associated with an increase in protein and calories delivered and a shorter time to target dose of nutrition. Compared with gastric feeding, when the results of 7 randomized trials were aggregated statistically, small bowel feeding was associated with a reduction in pneumonia (relative risk, 0.76; 95% confidence intervals, 0.59, 0.99). There was no difference in mortality rates between the 2 groups. CONCLUSIONS: Small bowel feeding may be associated with a reduction in gastroesophageal regurgitation, an increase in nutrient delivery, a shorter time to achieve desired target nutrition, and a lower rate of ventilator-associated pneumonia.

Critical Illness↗

PubMed2005

Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study.

BACKGROUND: The influence of labor epidural fentanyl on the neonate is controversial. The purpose of this study was to determine whether epidural fentanyl has an impact on breast-feeding. METHODS: Women who previously breast-fed a child and who requested labor epidural analgesia were randomly assigned in a double-blinded manner to one of three groups: (1) no fentanyl group, (2) intermediate-dose fentanyl group (intent to administer between 1 and 150 microg epidural fentanyl), or (3) high-dose epidural fentanyl group (intent to administer > 150 microg epidural fentanyl). On postpartum day 1, the mother and a lactation consultant separately assessed whether the infant was experiencing difficulty breast-feeding, and a pediatrician assessed infant neurobehavior. All women were contacted 6 weeks postpartum to determine whether they were still breast-feeding. RESULTS: Sixty women were randomly assigned to receive no fentanyl, 59 were randomly assigned to receive an intermediate dose, and 58 were randomly assigned to receive high-dose fentanyl. On postpartum day 1, women who were randomly assigned to receive high-dose fentanyl reported difficulty breast-feeding (n = 12, 21%) more often than women who were randomly assigned to receive an intermediate fentanyl dose (n = 6, 10%), or no fentanyl (n = 6, 10%), although this did not reach statistical significance (P = 0.09). There was also no significant difference among groups in breast-feeding difficulty based on the lactation consultant's evaluation (40% difficulty in each group; P = 1.0). Neurobehavior scores were lowest in the infants of women who were randomly assigned to receive more than 150 microg fentanyl (P = 0.03). At 6 weeks postpartum, more women who were randomly assigned to high-dose epidural fentanyl were not breast-feeding (n = 10, 17%) than women who were randomly assigned to receive either an intermediate fentanyl dose (n = 3, 5%) or no fentanyl (n = 1, 2%) (P = 0.005). CONCLUSIONS: Among women who breast-fed previously, those who were randomly assigned to receive high-dose labor epidural fentanyl were more likely to have stopped breast-feeding 6 weeks postpartum than woman who were randomly assigned to receive less fentanyl or no fentanyl.

Adjuvants, Anesthesia↗

PubMed2002

Breastfeeding practices in an area of high HIV prevalence in rural South Africa.

UNLABELLED: Exclusive breastfeeding (EBF) from 0 to 6 mo of age is recommended by the World Health Organization as the optimal feeding method for infants, including infants of human immunodeficiency virus (HIV)-infected women from developing countries who choose to breastfeed. EBF may be associated with less risk of postnatal HIV transmission than mixed feeding, but is still uncommonly practised for reasons that are poorly understood. This study aimed to assess EBF rates and the impediments to EBF in a South African rural area of high HIV prevalence where most mothers are unaware of their status. In a longitudinal study, 130 women attending 3 clinics, chosen for their disparate socioeconomic characteristics, were interviewed at weekly postnatal intervals. Follow-up to 16 wk was completed on 119 infants. In an additional cross-sectional survey mothers of 445 infants, aged 0-12 mo, attending immunization clinics were interviewed. In the longitudinal study 46% of infants received non-breast-milk fluids or feeds within 48 h of birth; only 10% were exclusively breastfed for 6 wk and 6% for 16 wk. Supplements, most commonly formula milk, were introduced for perceived milk insufficiency. Feeding choices were mainly self-determined (43% of women), but health staff (22%) and grandmothers (16%) were cited as sources of advice. In the cross-sectional survey caregivers reported that 47% of infants aged 2 wk, 40% aged 6 wk and 33% aged 12 wk had been exclusively breastfed since birth. CONCLUSION: EBF is uncommon in this area in spite of a baby-friendly hospital initiative in the district. Strategies to promote exclusive breastfeeding in developing countries where HIV and infant feeding policies are being formulated must strongly address local perceptions on the need for supplements and sources of feeding advice.

Breast Feeding↗

PubMed1993

[Promotion program for breast feeding in Poland. II. Analysis of the breast feeding situation in Poland].

Assessment of breast-feeding situation in Poland was based on three kinds of nation-wide surveys conducted in 1988: newborn feeding and breast feeding routines in maternity wards epidemiology of breast-feeding and other feeding methods in first six months of infant life KAP study among MCH professionals The major findings of the surveys were: conflicting with lactation maternity wards routines especially: very initiation of breast-feeding, administration of liquids and formulas, rigid feeding schedule, separation of newborns from the mothers too early supplantation of breast-feeding lack of current breast-feeding knowledge among MCH professionals.

Breast Feeding↗

PubMedDate not supplied

Nursing-bottle syndrome caused by prolonged drinking from vessels with bill-shaped extensions.

Our investigating 186 infants between the ages of one and six with carious destruction of the maxillary primary incisors, it was learned which risk factors were responsible for the condition known as nursing bottle syndrome. One hundred and twenty-eight infants (68.8 percent) were given a nursing bottle, twelve (6.5 percent) a feeding cup or other bottles with bill- shaped extensions, and forty-one (22.0 percent) both a nursing bottle and vessels with bill-shaped extensions; in all cases the feeding was excessive and prolonged beyond the first year of life. An additional five infants (2.7 percent) were breast-fed excessively beyond the first year. The results confirm the risk of tooth destruction, typical of nursing bottle syndrome, by prolonged and frequent consumption of cariogenic beverages from vessels with bill-shaped extensions. It is important, therefore, that a warning regarding dental health hazards of such feeding methods be issued.

Age Factors↗

PubMedDate not supplied

Evaluation of cholesterol absorption in rats using markers labeled with stable isotopes. Effect of complete bile diversion.

BACKGROUND/AIMS: An easily performed method to measure cholesterol absorption with isotope labeled cholesterol and beta-sitostanol in humans is described. The first aim of the study was to show whether this method can also be used in rats. Secondly, to see whether complete bile diversion results in a complete loss of cholesterol absorption. METHODOLOGY: Cholesterol absorption was evaluated in rats by the constant isotope feeding method using [2H6]cholesterol and [2H4]sitostanol as markers. Fecal samples were analyzed by gas-chromatography/mass spectrometry. RESULTS: In 8 rats with intact enterohepatic circulation of bile acids, cholesterol absorption averaged 61 (3% (SD) (range: 54-69%)). Complete bile diversion was followed by an almost total loss of cholesterol absorption (5.5+/-0.6%, range: 2.4-6.9%, n=7). CONCLUSIONS: The results indicate that deuterated cholesterol and deuterated sitostanol are reliable markers for measurement of cholesterol absorption in rats and that bile acids are essential for cholesterol absorption.

Animals↗

PubMed1988

Factors associated with maternal choice to provide breast milk for low birthweight infants.

Factors associated with maternal choice to provide milk for premature infants were investigated in 925 mother/infant pairs in five hospitals. A well educated, married, primiparous mother aged 20 or over who delivered a baby boy by caesarean section was nearly 1000 times more likely to choose to express her milk than a mother who was poorly educated, single, multiparous, and aged under 20, delivering a female infant vaginally. Evidence from the five centres suggested that hospital staff have little influence on a mother's choice of feeding method. The major differences between the populations of babies whose mothers do or do not choose to provide milk, raise important issues concerning the interpretation of data from non-randomised clinical trials of feeding premature infants.

Birth Order↗

PubMed2005

Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding.

OBJECTIVES: To investigate the occurrence of and risk factors for late-onset septicemia (LOS) in a national cohort of extremely premature infants who received very early full human milk feeding. METHODS: A prospective study of all infants born in Norway in 1999 and 2000 with gestational age of <28 weeks or birth weight of <1000 g was performed. Extensive clinical information, including data on feeding practices and episodes of septicemia, was collected on predefined forms. LOS was defined as growth of bacteria or fungi in blood cultures in conjunction with clinical symptoms consistent with systemic infection occurring after day 6 of life. Cox regression models, including models allowing for time-dependent covariates, were applied in the analysis of LOS. RESULTS: Of 464 eligible infants, 462 (99.6%) were enrolled and 405 (87.7%) survived until day 7. LOS was diagnosed for 80 (19.7%). The predominant pathogens were coagulase-negative staphylococci, followed by Candida spp. Case fatality rates associated with septicemia were 10% in general and 43% for Candida spp septicemia. Necrotizing enterocolitis or bowel perforation was diagnosed for 19 infants (4%). Enteral feeding with human milk was initiated within the third day for 98% of patients, and 92% were receiving full enteral feeding (FEF) with human milk within the third week. Both high Clinical Risk Index for Babies scores and an umbilical venous catheter in situ at 7 days of age significantly predicted LOS. However, the overall most influential risk factor for LOS was the number of days without establishment of FEF with human milk, with an adjusted relative risk of 3.7 (2.0-6.9) for LOS if FEF was not established within the second week of life. CONCLUSIONS: The incidence and case fatality rate of septicemia for this cohort of extremely preterm infants were lower than values in comparable studies. The main difference, compared with other studies, was the feeding practice, and the data suggest that very early FEF with human milk significantly reduces the risk of LOS among extremely premature infants.

Candida↗

PubMed2005

Culture-independent analysis of fecal microbiota in infants, with special reference to Bifidobacterium species.

Fecal microbiota of 31 breast-fed, 26 mix-fed, and 11 bottle-fed infants were analyzed by using terminal restriction fragment length polymorphism (T-RFLP), and culture method. We first determined the total and cultivated bacterial counts in infant fecal microbiota. Only approximately 30% of bacteria present in fecal microbiota were cultivable while the remainder was yet-to-be cultured bacteria. Sixty-eight fecal samples were divided into two clusters (I and II) by T-RFLP analysis, and then subdivided into five subclusters (Ia, Ib, IIa, IIb and IIc). There was no clear relationship between clusters and feeding method. A proportion of bifidobacteria was detected in the fecal material by PCR method using species-specific primers. The predominant Bifidobacterium spp. was Bifidobacterium longum longum type (43 samples (63.2%)), followed by B. longum infantis type (23 samples (33.8%)) and B. breve (16 samples (23.5%)). The distribution of Bifidobacterium spp. was similar in the three feeding groups. In contrast, the high incidence of B. breve in cluster I, especially subcluster Ia and B. longum longum type in cluster II, especially subcluster IIa and IIc were characterized by T-RFLP method. Our results showed that the colonization of Bifidobacterium spp. in infant feces correlated with the T-RFLP clusters.

Bifidobacterium↗

PubMed1995

Influences on breast-feeding by lower-income women: an incentive-based, partner-supported educational program.

OBJECTIVE: To determine the effects of a partner-supported, incentive-based educational program on rates and duration of breast-feeding among low-income women. DESIGN: Women who expressed a willingness to participate in the breast-feeding educational program were randomly assigned to one of two groups: an intervention group and a control group who received usual breast-feeding education. SETTING: Clinics of the Special Supplemental Food Program for Women, Infants, and Children in Flagstaff, Ariz. SUBJECTS: Sixty-eight primiparous pregnant women with expected due dates between May 1992 and December 1992 were willing to participate in the study. Of these, 34 were randomly assigned to the intervention group and 34 to the control group. Approximately 81% of the women completed the study: 29 in the control group and 26 in the intervention group. INTERVENTION: The intervention consisted of special incentives (prizes) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth. Women were also encouraged to use a breast-feeding support program in which peers serve as role models. MAIN OUTCOME MEASURES: The primary outcome measure was infant feeding method. Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks, 6 weeks, and 3 months postpartum. STATISTICAL ANALYSES PERFORMED: Binomial proportional analyses of the feeding data were performed. RESULTS: Women in the intervention group reported a higher percentage of breast-feeding at all measurement times. APPLICATIONS: These findings suggest that incentives, such as donated prizes, can be used to attract primiparous women from lower socioeconomic groups, along with their partners, to participate in educational interventions designed to promote breast-feeding. Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding.

Adolescent↗

PubMed1996

An investigation into feeding errors of 0-4-month-old infants.

This study was carried out on 206 infants seen consecutively at the Pediatric Clinic of our hospital. The feeding errors investigated were: The proportion of infants not exclusively breastfed, incorrect dilution of formula milk, incorrect dilution of cow's milk, rice flour feed prepared with water, and the use of rice water as a feed. The feeding methods of the infants were compared with their weight for height. Of those infants exclusively breastfed 83 percent were found to be above the median standard of weight-for-height. In those receiving supplementary feeds this ratio was significantly lower (P < 0.05). In 20 percent of cases where the infant had received formula milk and in 14 percent of cases where the infant had received cow's milk, the milk was found to be overdiluted by more than 40 percent.

Breast Feeding↗

PubMed2004

Teenage mothers and breastfeeding: does paternal age make a difference?

This descriptive investigation explores the impact of paternal age on a teenage mother's decision regarding infant-feeding method during the postpartum hospital stay. Eighty-six teenagers who delivered a live birth were asked the age of the fathers of their babies and what, if any, influence the fathers had on infant feeding. Although the fathers of the babies frequently voiced an opinion regarding infant feeding, teenage mothers partnered with older men were less likely to breastfeed during the postpartum hospital stay than were teenagers partnered with male peers. Implications for future research and clinical nursing practice are presented.

Adolescent↗

PubMed1999

Feeding outcome in breast-fed term babies supplemented by cup or bottle.

OBJECTIVE: To describe the feeding method at discharge from midwifery care of term babies supplemented either by cup or bottle while in hospital. DESIGN: A retrospective review of the obstetric and midwifery records of 531 consecutively born babies. SETTING: A large maternity unit, with an integral General Practitioner Unit, in an inner city in the south of England. PARTICIPANTS: 63 term breast-feeding babies; 30 supplemented by cup and 33 supplemented by bottle. MAIN OUTCOME MEASURE: Breast feeding on discharge from midwifery care. FINDINGS: There were no significant differences between the bottle and cup supplementation groups in relation to feeding outcome (OR 1 94 95% CI 0.61, 6.31), or in the length of time from the beginning of supplementation to leaving hospital (median difference 1 95% CI 0, 1) or discharge from midwifery care (median difference 0 95% CI, -1, 1). Babies who received supplements of expressed breast milk, as opposed to artificial milk, were more likely to be supplemented by cup (OR 4 29, 95% CI 0.9, 26.91; p = 0.05), but were not more likely to be discharged from midwifery care breast feeding (OR 3.79, 95% CI 0.69, 38.36). CONCLUSION: Owing to the small scale and retrospective nature of this survey, its results must be viewed with caution. However, given the apparent lack of evidence in this area, prospective work should be undertaken to examine the most appropriate method of supplementation for term babies. Generalisation from work related to babies in special care baby units is no longer acceptable.

Bottle Feeding↗

PubMed1985

Tube feeding of infants and children.

Advances in tube feeding methods, equipment, and formulas have helped to make this form of nutritional support appropriate for and well tolerated by children with a wide variety of clinical problems. This article describes advances in the field of enteral feeding and discusses the management of common problems associated with this technique.

Adolescent↗

PubMed1996

The response of highly productive rabbits to dietary sulphur amino acid content for reproduction and growth.

This study investigated the sulphur amino acid (SAA) requirements of rabbits. Five diets, containing 0.48-0.72% crude SAA, were formulated by supplementing a basal diet with DL-methionine. The apparent methionine digestibility (%) was 71.4 +/- 1.1 in the basal diet and 102.9 +/- 0.9 for DL-methionine, as estimated by the difference method. Feeding trials were carried out using 370 rabbit does and 1 195 weanling rabbits slaughtered at 2-2.1 kg body weight. Milk production was measured in 80 lactations. Carcass traits were determined in 125 rabbits. The dietary SAA content affected several productive traits, such as milk production, parturition interval, growth rate, carcass quality and feed efficiency. When the diets were compared using orthogonal contrasts, a minimum requirement of 0.54% crude or 0.40% digestible SAA was determined. Further responses in performance were observed, however, when the data were analysed by regression methods. The values of crude and digestible SAA for optimal production were, respectively, 0.63 and 0.49% (rabbit does) and, at least, 0.72 and 0.58% (growing rabbits).

Amino Acids, Sulfur↗

PubMed1999

Comparative study of the PARK and ASTRAL post-accidental decision support software.

The French radioecological assessment model ASTRAL and the German model PARK have been developed to evaluate the radiological situation in the case of an accidental release of radionuclides and a widespread contamination of the environment. For decision makers it is of importance that the results on foodstuff contamination and on dose to humans are in fairly good agreement, when areas of the common border are affected. Therefore a comparative study has been done for two scenarios, assuming accidental releases on 1 June and 1 October. The study indicates that the models' structures and the transfer parameters are in good agreement. Only model principles for root vegetables are different in both models. Significant differences in results on the contamination of foodstuff and on dose to humans by ingestion are caused by different assumptions on dates of harvest and feeding methods of animals. A corresponding harmonization is essential with respect to decision making.

Animal Feed↗

PubMedDate not supplied

Differential effects of breast- and formula-feeding on preterm infants' sleep-wake patterns.

OBJECTIVE: To compare sleep-wake patterns of breastfed and formula-fed preterm infants. DESIGN: Data were taken from an exploratory study of infant biorhythm maturation. Parents completed a 24-hour diary of infant Sleep, Awake, and Cry states and feedings, recorded at 30-minute intervals. Infant health data were collected from medical records and parents' reports. SETTING: Infants were studied in the home after discharge from a neonatal intensive-care unit. PARTICIPANTS: The convenience sample included 12 breastfed and 25 formula-fed preterm infants (gestational age, 26-33 weeks; corrected postnatal age, 4-6 weeks). Groups were comparable in terms of gestational age, postnatal age, Apgar scores, maternal age, and home environment. MAIN OUTCOME MEASURE: The 24-hour recording period was divided into day (0600-1800) and night (1800-0600). Study variables were Day, Night, and 24-hour Sleep, Awake, and Cry. RESULTS: Breastfed preterm infants exhibited more Day Cry and 24-hour Cry than did formula-fed infants. Infants demonstrated a diurnal pattern in Cry, Awake, and Sleep. Breastfed preterm infants cried approximately 1 hour per day more than formula-fed infants. CONCLUSION: Preterm breastfed infants experienced more cry than did formula-fed infants. The relationship between feeding method and sleep-wake pattern has implications for supporting lactation as well as for research design.

Analysis of Variance↗

PubMed2006

Child feeding and human rights.

BACKGROUND: The human right to adequate food needs to be interpreted for the special case of young children because they are vulnerable, others make the choices for them, and their diets are not diverse. There are many public policy issues relating to child feeding. DISCUSSION: The core of the debate lies in differences in views on the merits of infant formula. In contexts in which there is strong evidence and a clear consensus that the use of formula would be seriously dangerous, it might be sensible to adopt rules limiting its use. However, until there is broad consensus on this point, the best universal rule would be to rely on informed choice by mothers, with their having a clearly recognized right to objective and consistent information on the risks of using different feeding methods in their particular local circumstances. SUMMARY: The obligation of the state to assure that mothers are well informed should be viewed as part of its broader obligation to establish social conditions that facilitate sound child feeding practices. This means that mothers should not be compelled to feed in particular ways by the state, but rather the state should assure that mothers are supported and enabled to make good feeding choices.Thus, children should be viewed as having the right to be breastfed, not in the sense that the mother is obligated to breastfeed the child, but in the sense that no one may interfere with the mother's right to breastfeed the child. Breastfeeding should be viewed as the right of the mother and child together.

Journal Article↗