Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
JPEN J Parenter Enteral Nutr. 2018 Aug;42(6):1046-1060. doi: 10.1002/jpen.1049. Epub 2018 Jan 16.
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.
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.
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.
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.
慢性疾病患儿通常需要通过胃造口管（G 管）进行喂养。商业配方奶是最常用于肠内喂养的方法；然而，护理人员一直在要求使用搅拌管饲（BTF）作为替代方法。本研究的目的是评估在医疗复杂的儿科人群中使用 BTF 的可行性，并评估其对临床结果以及微生物群的影响。
纳入了 20 名儿科参与者。参与者依赖 G 管，且从商业配方奶中获得每日能量需求的≥75%。在 4 周的时间内，参与者从商业配方奶过渡到 BTF，并在接下来的 6 个月内监测营养摄入、胃肠道症状、口服喂养、药物使用和护理人员认知的变化。通过 16S rDNA 测序监测肠道微生物群的变化。
17 名参与者成功过渡到 BTF，1 名参与者过渡到口服喂养。与商业配方奶相比，参与者在使用 BTF 时需要增加 50%的热量来维持其体重指数。BTF 的微量营养素含量优于商业配方奶。使用 BTF 后，呕吐和使用酸抑制药物的发生率显著降低。粪便稠度和频率保持不变，而使用粪便软化剂的情况增加。粪便样本中的细菌多样性和丰富度显著增加，而变形菌门的相对丰度降低。护理人员对 BTF 更满意，并一致表示会推荐 BTF。
在医疗复杂的儿科人群中，不仅可以启动和维持 BTF，而且还可以改善临床结果和增加肠道细菌多样性。
