Nasogastric feeding at home: acceptability and safety

Article Abstract:

Nasogastric feeding is the provision of a liquid diet by way of a tube inserted into the nasal passages and down into the stomach. Enteral feeding (tube feeding) is increasingly being used to feed children at home, as more children with chronic diseases are found to be malnourished. Improved nutrition has benefited children with disorders such as Crohn's disease, cystic fibrosis, and heart, liver, or kidney disease. Enteral feeding at home was evaluated in 70 families, using a questionnaire to ask them about the experience. Children were aged six weeks to 15 years at the start of feeding programs. Feeding system set-up took from 3 to 15 minutes. In 59 families, parents shared joint responsibility for feeding, while in 11 families, a single parent was responsible. No parent remained awake all night during feeding, but 59 parents checked once during the night. Overnight feeding was given to 46 children, while 23 were fed during the day and night and one received daytime feedings only. Night feeding led to sleep disturbances in 35 children, chiefly due to urination or vomiting. Ten children also developed a cough, but this did not progress to gastro-esophageal reflux (backflow of food from the stomach to esophagus) and feeding was continued. Thirty-five children were reported to be more active and happy, and other important child health and family benefits were described. Thirty-six children, particularly older children, reported unwelcome interest by others in the tubes, and this was prevented by children performing their feeding at night and removing the tube daily. No major complications were found. The particulars of three different pump systems are discussed. The results indicate that home enteral feeding, if parents are well prepared and supported, is safe and beneficial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Children, Enteral feeding, Enteral nutrition, Chronically ill children, Diet therapy, Tube feeding, Home care, Diet therapy for children

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Egg and breast milk based nitrogen sources compared

Article Abstract:

Nourishing intravenous solutions based on the amino acid composition of eggs, a common source of protein, have been developed for adults and used with children. However, the nutritional requirements for protein and amino acids for infants may be much different from those for adults. The impact of two different nitrogen-based amino acid solutions on plasma amino acid levels, growth and nitrogen balance was evaluated in infants. For six days, each amino acid solution, based on either egg protein (Vamin 9 glucose) or breast milk (Vaminolact), was given to seven infants between 31 to 43 weeks old who required intravenous feeding after surgery. There were no statistical differences in age, weight, or intake of fluid, nitrogen or carbohydrate; the only difference was the amino acid composition of the solution. After the study, each group showed significant, but not different, increases in weight and head circumference. Nitrogen retention was equivalent in each group, as well. The plasma amino acid profiles were similar between the two groups, except the concentrations of phenylalanine and tyrosine, two essential amino acids, were considerably above upper limits in the egg-based solution. It is well established that abnormal levels and metabolism of tyrosine and phenylalanine, as seen in uncontrolled phenylketonuria, usually results in long-term developmental and intellectual impairment. The authors contend that amino acid solutions that are specifically patterned after breast milk to more closely satisfy the infants' requirements will probably reduce the risk of neurotoxicity associated with amino acid imbalance. In addition, weekly monitoring of plasma amino acid levels, particularly phenylalanine, is recommended for infants who are being fed a phenylalanine-rich solution. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Infants (Newborn), Newborn infants, Nutrition, Nutritional assessment, Amino acid metabolism, Protein nitrogen

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Crohn's disease of the lung

Article Abstract:

Crohn's disease is characterized by inflammation of the small intestine, but may affect other organs. The development of granulomas, or granular growths, in the lungs has not been previously reported association with Crohn's disease. A case is described of a 17-year-old boy with pulmonary consolidation, a process in which portions of the lung become solid due to engorgement of the lungs, which developed two years after he was diagnosed with Crohn's disease. A tissue sample of the lung revealed the presence of granuloma consisting of epithelial-like cells. He did not respond to treatment with the antibiotic amoxicillin, and had symptoms of persistent cough and fever. Treatment with the antibiotic erythromycin caused some improvement in symptoms, but several weeks later, he became worse, developing a productive cough and difficulty breathing after moderate exercise. He was then treated with rifampin and isoniazid, which are antibacterial agents commonly used to treat tuberculosis, for three weeks, at which time there was no evidence of infection. The fever and lung abnormalities resolved over an additional three weeks. The patient suffered three recurrences of Crohn's disease, which were associated with abdominal pain, diarrhea, and weight loss, but no respiratory symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Complications and side effects, Pediatric diseases, Lung diseases, Crohn's disease, Crohn's disease in children, Pulmonary manifestations of general diseases, Respiratory symptoms

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