Extrauterine growth restriction is much popular in China and it is still challenge job for pediatricians. This article described the benefits for PICC in route of PN choice. New fat emulsions were appeared recently years, however they are no strong evidence for using in premature infants and need do more clinical trial. Parenteral nutrition associated with liver damage still is a serious complication of TPN and we encourage early enteral feeding, appropriate calore intake, anti sepsis for prevention.
Enteral Nutrition ; Humans ; Infant, Newborn ; Infant, Premature ; Nutritional Support ; Parenteral Nutrition, Total ; adverse effects

Child ; Child, Preschool ; Enteral Nutrition ; adverse effects ; Female ; Humans ; Male ; Pancreatitis ; etiology ; Sodium Chloride

As a serious disease of death and disability, stroke constitutes a serious threat to human health. Because of stroke patients often have high-risk factors of malnutrition such as dysphagia and autonomic eating disorder, the hospitalization time, mortality and disability rate of stroke patients increases. Nutritional therapy can effectively improve the malnutrition of patients, which are of great significance for the treatment and rehabilitation of stroke and the prevention of its complications. Nutrients are important components of nutrition therapy, and different ways of nutrition therapy directly affect the effect of treatment. This article summarizes effects of nutrients and different nutritional treatments on stroke prevention, morbidity and treatment, and provides a theoretical basis and new thinking for further reducing the incidence rate of stroke, improving the quality of life in patients and reducing the financial burden of society and family.
Enteral Nutrition/adverse effects* ; Humans ; Malnutrition/prevention & control* ; Nutritional Status ; Nutritional Support/adverse effects* ; Quality of Life ; Stroke/prevention & control*

OBJECTIVETo analyze the efficacy of percutaneous endoscopic gastrostomy (PEG) in pediatric patients.

METHODFrom October 2011 to October 2014, children in the gastrointestinal ward of Guangzhou Women and Children's Medical Center received PEG or jejunal tube PEG(JET-PEG). The success rate, operation time were recorded. The changes of their weight, enteral nutrition calories and the incidence of pneumonia before and after the first 6 months of operation were compared. Follow-up was conducted until October 2014, the recent and long term complications, the length of indwelling time, the replacement or removal of the tube were recorded, the patients swallowing function or the primary disease's outcomes were observed.

RESULTOf the 13 cases, 10 were male, 3 were female, their average age was 2 years (range 1.8 months-9 years). We performed PEG for 12 of the patients who had congenital craniofacial problems that led to feeding difficulties or recurrent cough and pneumonia (6/12), or neurological disorders (6/12) with inability to swallow, and in one case JET-PEG was performed, this child suffered from chronic intestinal pseudo-obstruction with vomiting and abdominal distension. The gastrostomy was successful in all the patients through one operation, the average operation time of PEG was (25 ± 3) minutes, JET-PEG was 60 minutes. One local skin infection was noted, no long-term complication occurred. In the first 6 months after operation, all the patients gained weight((5.5-30.5) kg postoperation vs. (3.0-30.0) kg preoperation), and 12 cases' enteral nutrition calories increased (from (209-502) to(272-543) kJ/(kg·d)), the incidence of pneumonia decreased in the children who had recurrent pneumonia before the operation (from (0-1.5) to (0-0.16) per month). Until October 2014, their average length of gastric tube indwelling time was 17.8 months (range 4-36 months). In 4 cases PEG tube was removed when they could eat completely independently, the other 9 needed enteral vein nutrition via PEG tube or jejunal tube, in 3 of them balloon type gastric fistula tube was applied. Two of the 13 cases who had cleft palate received stomatological operations when their weight grew to meet the standard.

CONCLUSIONPEG and JET-PEG are safe and effective method for enteric nutrition feeding in pediatrics, the technique causes minimal trauma and has rapid postoperative recovery, few complications, good aesthetic appearances and simple nursing, it can significantly improve their nutritional status and quality of life.

Child ; Child, Preschool ; Enteral Nutrition ; methods ; Female ; Gastrostomy ; adverse effects ; Humans ; Incidence ; Infant ; Male ; Nervous System Diseases ; therapy ; Pneumonia ; therapy

OBJECTIVETo explore the feasibility and safety of enteral nutrition in preoperative bowel preparation for rectal cancer patients undergoing radical operation.

METHODSSixty rectal cancer patients undergoing selective low anterior resection were randomized into the trial group(n=30) and the control group(n=30). Patients in the trial group received clean liquid integral protein diet for 3 days before operation without mechanical bowel preparation. Patients in the control group received traditional diet and mechanical bowel preparation. The intraoperative and postoperative clinical data, the quality of bowel preparation, postoperative complications, and nutritional parameters were compared between the two groups.

RESULTSThere were no significant differences in clinicopathological characteristics between the two groups before operation. The operative time, blood loss, quality of bowel preparation as well as postoperative hospital stay were not significantly different(all P>0.05). While the time to first flatus [(2.53±0.91) d vs. (3.03±0.68) d] and semi-liquid diet intake[(3.95±0.83) d vs. (4.52±1.14) d] were significantly shorter in the trial group as compared with the control group(all P<0.05). There were no death and no significant difference in postoperative complications [16.7%(5/30) vs. 20.0%(6/30), P>0.05]. The levels of postoperative total protein, albumin, and prealbumin decreased significantly. Meanwhile, the levels of postoperative albumin[(36.2±2.5) g/L vs. (33.5±2.6) g/L, P<0.01] and prealbumin [(325.4±28.2) mg/L vs. (302.5±34.2) mg/L, P<0.01] in the trial group were significantly higher than those in the control group.

CONCLUSIONSPreoperative enteral nutrition can replace the mechanical bowel preparation with better efficacy, and improve the postoperative nutritional status without increasing surgical risk in rectal cancer patients undergoing radical operation.

Digestive System Surgical Procedures ; adverse effects ; Enteral Nutrition ; Humans ; Postoperative Complications ; Preoperative Care ; methods ; Rectal Neoplasms ; surgery

PURPOSE: This study was performed to test the clinical usefulness of the glucose test strip method for early detection of pulmonary aspiration in tube fed patients. METHOD: The subjects for the study were 36 patients who were receiving enteral feedings and 39 patients who were not given enteral feedings. For the analysis, the tube fed patients were divided into two groups (clinically significant aspiration and no aspiration) according to criteria. RESULT: The mean glucose concentration of tracheal secretions from non enteral fed patients was 26.35mg/dl and were lower than those concentrations found in tube fed patients (32.75mg/dl). The mean glucose concentration of the aspiration group was 45.60mg/dl and the glucose concentration of the non aspiration group was 19.93mg/dl. The difference was statistically significant (t=2.163, p=. 038). More subjects in the no aspiration group (73%) than the aspiration group (56%) had glucose concentrations below 20mg/dl. After deleting the cases that had samples containing blood, glucose concentrations of tracheal aspirates were lower in both groups. CONCLUSION: The glucose level of the aspiration group was significantly lower than the no aspiration group and more subjects in the aspiration group had a glucose level higher than 101mg/dl. Therefore, the glucose test of tracheal secretions in tube fed patients could be a desirable test for screening for tracheal aspiration. Especially the patient who is showing repeatedly high glucose levels should not be given feedings until reassessment is completed.
Adult ; Aged ; Aged, 80 and over ; Enteral Nutrition/*adverse effects ; Female ; Glucose/*analysis ; Humans ; Intubation, Gastrointestinal/*adverse effects ; Male ; Middle Aged ; Pneumonia, Aspiration/*diagnosis ; *Reagent Strips ; Trachea/*secretion

Percutaneous endoscopic gastrostomy (PEG) has been increasingly used in treating patients with neurogenic dysphagia to improve nutrition status and prevent choking. PEG is mostly used for stroke and amyotrophic lateral sclerosis, although more evidence-based researches are required to assess the timing, risks, and survival benefits. Its application in senile dementia is still controversial.
Alzheimer Disease ; surgery ; Amyotrophic Lateral Sclerosis ; surgery ; Enteral Nutrition ; methods ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Humans ; Nervous System Diseases ; surgery

BACKGROUND/AIMS: Knowledge of the risk factors associated with adverse outcomes after percutaneous endoscopic gastrostomy (PEG) may be helpful for developing PEG recommendations. The purpose of this study was to identify the clinical risk factors associated with adverse clinical outcomes after PEG, especially regarding the use of proton pump inhibitors (PPIs). METHODS: We retrospectively reviewed the data from PEG patients at seven university hospitals between June 2006 and January 2012. All patients were followed up through February 2012 after PEG, and the clinical risk factors for adverse clinical outcomes after PEG were analyzed. RESULTS: Data from 1,021 PEG patients were analyzed. PPI users were more frequently included in the complication group than the noncomplication group (p=0.040). PEG-related complications (p=0.040) and mortality (p=0.003) were more frequent in the PPI group than in the control group. In the subgroup analysis of complicated PEG cases, infectious complications were more frequently found in the PPI group than in the control group (35.8% vs 27.8%). After adjustment for multiple possible confounding factors, PPI users (odds ratio, 1.531; 95% confidence interval, 1.017 to 2.305) and diabetic patients had increased mortality after PEG. CONCLUSIONS: PPI use may be associated with adverse outcomes in patients with PEG; however, further prospective studies investigating this issue are warranted.
Aged ; Case-Control Studies ; Enteral Nutrition/adverse effects/mortality ; Female ; Gastroscopy/*adverse effects/mortality ; Gastrostomy/*adverse effects/mortality ; Humans ; Male ; Prognosis ; Proton Pump Inhibitors/*adverse effects ; Republic of Korea ; Retrospective Studies ; Risk Factors

BACKGROUNDEarly enteral feeding (EF) may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications "enteral refeeding syndrome", as a subtype of refeeding syndrome, because they are likely to result from long-term lack of lumen nutrition. The aim of this study was to investigate the characteristics of enteral refeeding syndrome after long-term total parenteral nutrition (TPN), and the solution for the disease.

METHODSWe collected the clinical data of 100 patients with gastrointestinal fistula, who were cured from Apirl 2001 to July 2002. Their fasting time, daily stool frequency, body temperature, heart rate, respiratory rate, levels of transaminases, alkaline phosphatase (AKP), and gamma-glutamylcyclotransferase (gamma-GT), white blood cell count, and systemic inflammatory reaction syndrome (SIRS) score were recorded before and 1, 3, 5, 10, and 15 days after EF. Student's t test and analysis of variance were used to analyze the data.

RESULTSOf the 100 patients, 56 were cured after selective resection of intestinal fistula, 15 were cured by emergency operation, and 29 recovered spontaneously. The levels of AKP and gamma-GT increased significantly on the 3rd day after EF [On the 3rd day after EF, (243.0 +/- 121.6) U/L and (177.2 +/- 109.9) U/L vs. before EF (181.5 +/- 127.5) U/L and (118.4 +/- 94.2) U/L, P < 0.05], and decreased gradually afterwards. The SIRS scores on the 1st day (1.05 +/- 1.08) and 3rd day (0.96 +/- 1.11) after EF were significantly higher than that before EF (0.72 +/- 0.84), then decreased to 0.83 +/- 0.91, 0.49 +/- 0.73 and 0.32 +/- 0.60 on the 5th, 10th and 15th days after EF. The number of patients with diarrhea at 1, 3, 5, 10 and 15 days post-EF were 31, 26, 12, 13, and 7, respectively.

CONCLUSIONSThe longer the TPN lasts, the more severe the enteral refeeding syndrome becomes. Continuous EF is effective for the syndrome. Early enteral nutrition is useful in preventing it.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Diarrhea ; etiology ; Enteral Nutrition ; adverse effects ; Female ; Humans ; Infant ; Jaundice ; etiology ; Leukocyte Count ; Male ; Middle Aged ; Parenteral Nutrition, Total ; adverse effects ; Syndrome ; Systemic Inflammatory Response Syndrome ; etiology ; gamma-Glutamyltransferase ; blood

OBJECTIVETo explore the clinical value of percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) in critically ill patients.

METHODSWe retrospectively analysed the clinical data of 30 critically ill patients who received PEG/J in our hospital. The indications, key operation procedures, peri-operative preparation, complications, and efficacy were recorded.

RESULTSTwenty-nine critically ill patients successfully received PEG/J. The mean operation time of PEG and PEJ were (7.5 +/- 2.5) min and (12.5 +/- 8.2) min, respectively, and the duration of tube functioning was (230 +/- 159) d; no procedure-related complications and serious complications were observed. Complications included local soft tissue infection (n = 1), J-tube dislodgment (n = 1), and obstruction of jejunal tube (n = 2). The serum levels of albumin and pre-albumin increased 4 weeks after operation; however, no significant difference was observed.

CONCLUSIONPEG/J is an effective, micro-invasive, safe, and convenient approach to establish a long-term gastrointestinal nutrition route for critically ill patients.

Aged ; Aged, 80 and over ; Critical Illness ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin ; metabolism