Kelsey Gallagher1, Annika Flint2, Marialena Mouzaki3, Andrea Carpenter1, Beth Haliburton1, Louise Bannister1, Holly Norgrove4, Lisa Hoffman5, David Mack6, Alain Stintzi2, Margaret Marcon3. 1. Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Ontario, Canada. 2. Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 3. Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 4. Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada. 5. Rehabilitation Services, Hospital for Sick Children, Toronto, Ontario, Canada. 6. Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: Chronically ill children often require feeding via gastrostomy tubes (G-tubes). Commercial formula is most commonly used for enteral feeding; however, caregivers have been requesting blenderized tube feeds (BTFs) as an alternative. The objective of this study was to evaluate the feasibility of using BTFs in a medically complex pediatric population and assess their impact on clinical outcomes, as well as the microbiota. METHODS: Twenty pediatric participants were included. Participants were G-tube dependent and receiving ≥75% of their daily energy requirements from commercial formula. Over 4 weeks, participants were transitioned from commercial formula to BTF and were monitored for 6 months for changes in nutrient intake, gastrointestinal symptoms, oral feeding, medication use, and caregiver perceptions. Changes to intestinal microbiota were monitored by 16S rDNA-based sequencing. RESULTS: Transition onto BTF was feasible in 17 participants, and 1 participant transitioned to oral feeds. Participants required 50% more calories to maintain their body mass index while on BTFs compared with commercial formula. BTF micronutrient content was superior to commercial formula. Prevalence of vomiting and use of acid-suppressive agents significantly decreased on BTFs. Stool consistency and frequency remained unchanged, while stool softener use increased. The bacterial diversity and richness in stool samples significantly increased, while the relative abundance of Proteobacteria decreased. Caregivers were more satisfied with BTFs and unanimously indicated they would recommend BTFs. CONCLUSION: Initiation and maintenance of BTFs is not only feasible in a medically complex pediatric population but can also be associated with improved clinical outcomes and increased intestinal bacterial diversity.
BACKGROUND: Chronically ill children often require feeding via gastrostomy tubes (G-tubes). Commercial formula is most commonly used for enteral feeding; however, caregivers have been requesting blenderized tube feeds (BTFs) as an alternative. The objective of this study was to evaluate the feasibility of using BTFs in a medically complex pediatric population and assess their impact on clinical outcomes, as well as the microbiota. METHODS: Twenty pediatric participants were included. Participants were G-tube dependent and receiving ≥75% of their daily energy requirements from commercial formula. Over 4 weeks, participants were transitioned from commercial formula to BTF and were monitored for 6 months for changes in nutrient intake, gastrointestinal symptoms, oral feeding, medication use, and caregiver perceptions. Changes to intestinal microbiota were monitored by 16S rDNA-based sequencing. RESULTS: Transition onto BTF was feasible in 17 participants, and 1 participant transitioned to oral feeds. Participants required 50% more calories to maintain their body mass index while on BTFs compared with commercial formula. BTF micronutrient content was superior to commercial formula. Prevalence of vomiting and use of acid-suppressive agents significantly decreased on BTFs. Stool consistency and frequency remained unchanged, while stool softener use increased. The bacterial diversity and richness in stool samples significantly increased, while the relative abundance of Proteobacteria decreased. Caregivers were more satisfied with BTFs and unanimously indicated they would recommend BTFs. CONCLUSION: Initiation and maintenance of BTFs is not only feasible in a medically complex pediatric population but can also be associated with improved clinical outcomes and increased intestinal bacterial diversity.
Authors: Amy Y Spurlock; Teresa W Johnson; Ali Pritchett; Leah Pierce; Jenna Hussey; Kelly Johnson; Holly Carter; Stephen L Davidson; Manpreet S Mundi; Lisa Epp; Ryan T Hurt Journal: Nutr Clin Pract Date: 2021-08-31 Impact factor: 3.204