Köglmeier Jutta, Assecaira Ines, Banci Elena, De Koning Barbara, Haiden Nadja, Indrio Flavia, Kastelijn Wendy, Kennedy Denise, Luque Veronica, Norsa Lorenzo, Verduci Elvira, Sugar Analou
From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust London, United Kingdom.
the Medical University of Lisbon and Dietetic and Nutrition Department, University Hospital of Northern Lisbon, Lisbon, Portugal.
J Pediatr Gastroenterol Nutr. 2023 Jan 1;76(1):109-117. doi: 10.1097/MPG.0000000000003601. Epub 2022 Sep 2.
This joint position paper of the Committees of Allied Health Professionals (CAHP) and Nutrition (CON) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) provides a comprehensive guide for health professionals to manage blended diets in children via gastrostomy tubes.
A systematic literature search was performed from 1992 to 2021 using Pubmed, MEDLINE, and Cochrane Database of Systematic Reviews and recent guidelines reviewed. In the absence of evidence, recommendations reflect the authors' expert opinion. Final consensus was obtained by multiple e-mail exchange and virtual meetings of the CAHP and CON.
Reported benefits of blended diets include reduced GERD and infections, improved defecation, level of alertness and attention span, skin conditions, and appearance of hair and nails. Families report a sense of greater normality. Small case series, cross-sectional surveys, questionnaire-based small case studies, reports of personal experience, and single-center pilot studies are available in the medical literature. A total of 20 recommendations for practice were made based on the results and consensus process.
There is little evidence published to formally inform about the potential health benefits or risks of this practice and how to use it in the best way. This leaves health professionals caring for such patients in a relative vacuum regarding what to consider when providing a duty of care to patients and carers who wish to pursue this method of feeding. This article provides guidelines for safe and appropriate use of a BD, but more research is needed.
欧洲儿科胃肠病学、肝病学和营养学会（ESPGHAN）的联合健康专业人员委员会（CAHP）和营养委员会（CON）的这份联合立场文件，为卫生专业人员通过胃造口管管理儿童混合饮食提供了全面指南。
使用PubMed、MEDLINE和Cochrane系统评价数据库，对1992年至2021年的文献进行系统检索，并查阅近期指南。在缺乏证据的情况下，建议反映作者的专家意见。通过CAHP和CON的多次电子邮件交流和虚拟会议达成最终共识。
报告的混合饮食益处包括减少胃食管反流病和感染、改善排便、提高警觉性和注意力持续时间、改善皮肤状况以及头发和指甲外观。家庭报告感觉更加正常。医学文献中有小病例系列、横断面调查、基于问卷的小病例研究、个人经验报告和单中心试点研究。根据结果和共识过程共提出了20条实践建议。
几乎没有公开证据正式说明这种做法的潜在健康益处或风险以及如何以最佳方式使用它。这使得照顾此类患者的卫生专业人员在为希望采用这种喂养方法的患者和护理人员提供护理职责时，对于应考虑的事项处于相对信息真空状态。本文提供了安全合理使用混合饮食的指南，但仍需要更多研究。
