Blenderized enteral nutrition in pediatric short gut syndrome: Tolerance and clinical outcomes

Abstract

Background Blenderized feeds consisting of whole food components are emerging as a preferred approach to enteral nutrition. However, there is limited evidence‐based guidance for this strategy in short bowel syndrome (SBS). We aimed to explore the tolerance and clinical outcome of blenderized feeds in patients with SBS. Method We conducted a single‐center, retrospective study of blenderized feeds in pediatric SBS. Of the 376 patients screened, 58 met inclusion criteria. Three patients were excluded because of a history of bowel transplant. Demographics, clinical history, and nutrition history were collected and analyzed. Result Patients had improved diarrhea though worsening gas while receiving blenderized feeds. There was no significant difference in small bowel length in patients who discontinued blends compared with those who continued. However, patients with colonic resection were more likely to discontinue the blends. In a subgroup of patients who lost weight despite improved diarrhea (n = 19), most had a history of ileocecal valve (ICV) and colonic resection, but no difference in small bowel length compared with those who did not lose weight. Conclusion Our cohort of patients with SBS experienced improved gastrointestinal symptoms and stool quality on blenderized feeds. Patients without an ICV and with colonic resection were more prone to weight loss. Stepwise titration of blenderized formula with previous formula regimen may be needed in a subset of patients to optimize tolerance and weight gain. Further study is warranted to understand factors contributing to variable tolerance and weight gain on blenderized formulas to guide their use in patients with SBS.

A Digestive Cartridge Reduces Parenteral Nutrition Dependence and Increases Bowel Growth in a Piglet Short Bowel Model

“…36,37 Furthermore, existing approaches used in SBS-IF, such as teduglutide or blenderized feeding regimens, may not prevent these deficiencies. [38][39][40] There were no differences in villous height or crypt depth on intestinal morphometric analysis, potentially related to the short study duration (Figs. 4A-D).…”

“…Regardless, the changes in nutritional markers are important considering that steatorrhea in SBS is linked to micronutrient deficiencies and associated comorbidities such as metabolic bone disease, vision loss, neuropathies, cardiomyopathy, and coagulopathy, among others 36,37 . Furthermore, existing approaches used in SBS-IF, such as teduglutide or blenderized feeding regimens, may not prevent these deficiencies 38–40 …”

Thickness of commercial blenderized formulas adversely affects successful delivery via enteral feeding pumps

“…A recent case series described children with unexpected poor growth when switched to CBF due to presumed inaccuracies in formula delivery via feeding pumps 10 . In another retrospective case series of children with short bowel syndrome who transitioned to using blenderized feeds after using more traditional formulas, 11 the majority had improved diarrhea. Despite this, 47% of this group experienced weight loss or poor weight gain when using CBFs.…”

Clinical outcomes associated with blenderized tube feedings in adults: A systematic review

“…Several studies demonstrated improvement in gastrointestinal (GI) symptoms when children of various medical backgrounds, including neuromuscular, metabolic, and oropharyngeal disorders, were prescribed BTF 16–18 . In a small cohort ( n = 58) of children with short bowel syndrome, BTFs were associated with an improvement in diarrhea, but patients with a colonic resection struggled with weight maintenance 19 . The Blenderized Enteral Nutrition Study (BLEND) showed improvements in micronutrient provision, vomiting, and stool microbial diversity in a group of 20 hospitalized pediatric patients 20 .…”

“…[16][17][18] In a small cohort (n = 58) of children with short bowel syndrome, BTFs were associated with an improvement in diarrhea, but patients with a colonic resection struggled with weight maintenance. 19 The Blenderized Enteral Nutrition Study (BLEND) showed improvements in micronutrient provision, vomiting, and stool microbial diversity in a group of 20 hospitalized pediatric patients. 20 Data in adults using BTF are more sparse and limited to small study populations and specific disease states.…”