Continuous Enteral Feedings

Vanderhoof, Jon A.; Hofschire, Philip J.; Baluff, Mary A.; Guest, J.; Murray, Nancy D.; Pinsky, William W.; Kugler, John D.; Antonson, Dean L.

doi:10.1001/archpedi.1982.03970450067016

Cited by 47 publications

(7 citation statements)

References 12 publications

(3 reference statements)

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“…The ability to provide energy for growth can be affected by the type of feeding tube (NG, G, jejunal, etc. ), the feeding regime (continuous vs. bolus feeds) (40), and the type of formula (standard vs. therapeutic) prescribed.…”

Section: Discussionmentioning

confidence: 99%

Anthropometric growth and utilization of enteral feeding support in pediatric heart transplant recipients

Bannister

Manlhiot

Pollock-BarZiv

et al. 2010

Pediatric Transplantation

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We sought to outline trends in anthropometric growth before and after cardiac transplantation and to document our experience with the use of EFS in this population. A total of 130 patients (59% male) were enrolled and followed for a median of 4.4 yr after transplantation. Negative changes over time in weight z-score (EST: -0.256 [0.160] z/yr, p = 0.01), height z-score (EST: -0.214 [0.096] z/yr, p = 0.03), and BMI z-score (EST: -0.287 [0.161] z/yr, p = 0.07) were observed prior to transplantation. Significant increases in weight z-score (EST: +0.342 [0.143] z/yr, p < 0.001) and BMI z-score (EST: +0.396 [0.140] z/yr, p = 0.005) were seen in the first 18 months following transplantation. No further increases in height, weight, or BMI z-score were seen beyond this. Forty-two (32%) patients received EFS. Prior to transplantation, it was not found to be associated with change in anthropomorphic growth. Post-transplantation exposure to EFS was associated with a faster increase in weight z-score (EST: +0.480 [0.231] z/yr, p = 0.04) and height z-score over time (EST: +0.366 [0.141] z/yr, p = 0.01). Normalization of weight and height z-scores was not achieved during the study follow-up period. This study suggests that further investigation into the role of EFS is warranted to identify strategies to improve growth in pediatric heart transplant recipients.

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Section: Discussionmentioning

confidence: 99%

Anthropometric growth and utilization of enteral feeding support in pediatric heart transplant recipients

Bannister

Manlhiot

Pollock-BarZiv

et al. 2010

Pediatric Transplantation

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“…Inadequate caloric intake has been documented in poorly growing rats made hypoxemic by decreasing inspired oxygen concentration; normoxemic animals receiving the same caloric intake also grew poorly (12). In a group of cyanotic infants, continuous enteral nutrition improved their growth (43), supporting this finding. In contrast, Naeye (35) found that factors other than undernutrition contributed to growth retardation in chronically hypoxemic mice.…”

mentioning

confidence: 79%

“…Increased oxygen and substrate demand (41), abnormal hormonal status (42), inadequate caloric intake (43) or malabsorption (44), and local tissue alterations in blood flow and metabolism (35) have all been suggested as causes of failure to thrive in infants with congenital heart disease. Increased total body oxygen consumption and decreased insulin response to oral glucose (45,46) have been described in normoxemic infants in congestive heart failure, but not in hypoxemic infants with cyanotic heart disease (41,47).…”

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confidence: 99%

Chronic Hypoxemia in the Newborn Lamb: Cardiovascular, Hematopoietic, and Growth Adaptations

et al. 1985

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ABSTRAm. We have created a model of chronic hypoxemia in the newborn lamb by decreasing pulmonary blood flow in the presence of an atrial septal defect. Via a left lateral thoracotomy, we place an inflatable balloon around the pulmonary artery and perform an atrial septostomy under direct vision. We also insert several vascular catheters and place an electromagnetic flow transducer around the ascending aorta. Three days after surgery, we inflated the balloon in 11 lambs such that arterial oxygen saturation decreased to 60 to 75%. Studies were performed on these lambs twice weekly and weekly on 12 normoxemic lambs. Growth decreased sharply (47 2 123 versus 221 f 82 g/ day) at the onset of hypoxemia and remained low, although oxygen consumption followed the normal gradual decline. Heart rate remained elevated throughout the study. Arterial Pcoz levels decreased from 40 + 5 to 35 f 7 torr and remained low. Systemic blood flow decreased at balloon inflation but quickly returned to normal. Mixed venous saturation was low, but could decrease further with shivering. Systemic oxygen delivery decreased initially but returned to normal as Hb concentration rose (from 9.4 f 1.5 to 12.5 f 2.2 g/dl). P50 increased normally over the study period. Four of the 11 hypoxemic lambs died during the study. These data show that, in the chronically hypoxemic newborn, systemic oxygen delivery is maintained primarily by a rising Hb. Total body oxygen consumption is maintained at rest but is redistributed away from anabolic requirements and toward cardiorespiratory work. This signal to decrease growth occurs despite less than maximal oxygen extraction at rest. (Pediatr Res 19: 1004Res 19: -1010Res 19: ,1985 developed a model of a common cyanotic heart lesion to assess some of its cardiovascular and metabolic effects on the newborn lamb.Several authors have studied acute hypoxemia in the developing organism and elucidated its effects on general cardiovascular function (1-3), regional blood flow (1, 4, 5), metabolic activity (6, 7), and course of decompensation (1). The effects of sympathetic blockade (8, 9) and decreasing Hb oxygen affinity (10, 11) on the response to acute hypoxemia have also been addressed. Few studies have been performed on the chronically hypoxemic developing organism to understand the change from acute to chronic adaptations and the sequelae of these adaptations. Those studies have involved rodents and calves and have focussed on growth (1 2) and the development of the pulmonary (1 3) and coronary (14) vascular beds.We have designed a model to produce chronic hypoxemia in the newborn lamb and have studied lambs over several days of hypoxemia. We created a model of severe pulmonary stenosis with atrial septal defect. This simulates cyanotic lesions in which total pulmonary blood flow is reduced, which occurs in more than half of the infants with cyanotic heart disease (15). The degree of right ventricular outflow obstruction determines the drop in pulmonary blood flow and thus the magnitude of rightto-left atrial shu...

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“…Hypermetabolism (5,6), reduced visceral blood flow (1 1), tissue hypoxemia (12), reduced caloric intake (1,12), abnormalities in digestive enzymology (13)(14)(15)(16), and alterations in growth hormone and insulin metabolism (17,18) have been proposed as etiologies. However, previous studies in infants and children with cyanotic congenital heart disease have been complicated by difficulties in controlling for the multiple variables present in the clinical setting (6,8,(19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Decreased serum insulin-like growth factor-I associated with growth failure in newborn lambs with experimental cyanotic heart disease.

Bernstein

Jasper

Rosenfeld³

et al. 1992

J. Clin. Invest.

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To determine whether chronic hypoxemia results in alterations in endocrine function that may contribute to growth failure, we measured growth hormone (GH), somatomedins (insulin-like growth factors I and II, IGF-I and IGF-2), hepatic growth hormone receptors, and circulating IGF-binding proteins IGFBP-3 and IGFBP-2 in 12 newborn lambs with surgically created pulmonic stenosis and atrial septal defect, and in 10 controls. During chronic hypoxemia (oxygen saturation of60-74% for 2 wk), weight gain was 60% of control (hypoxemic, 135±20 vs. control, 216±26 g/d, P < 0.02). IGF-I was decreased by 43% (hypoxemic 253.6±29.3 SE vs. control 448.0±75.5 ng/ml, P = 0.01), whereas GH was unchanged (19.9±5.1 vs. 11.9±3.0 ng/ml, NS). The increase in IGF-1 was associated with a decrease in IGFBP-3 (hypoxemic, 5.09±1.25 vs. control, 11.2±1.08 arbitrary absorbency units per mm (Au -mm), P < 0.01), and increase in IGFBP-2 (0.47±0.03 vs. 0.19±0.13 Auk mm, P < 0.05), but no significant downregulation of hepatic GH receptors (hypoxemic, 106.1±20.1 vs. control, 147.3±25.9 fmol/mg, NS). Thus, chronic hypoxemia in the newborn is associated with a decrease in IGF-I and IGFBP-3 in the face of normal GH. This suggests peripheral GH unresponsiveness, similar to protein-calorie malnutrition or GH receptor deficiency dwarfism, but mediated at a level distal to the hepatic GH receptor. (J. Clin.

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Continuous Enteral Feedings

Cited by 47 publications

References 12 publications

Anthropometric growth and utilization of enteral feeding support in pediatric heart transplant recipients

Anthropometric growth and utilization of enteral feeding support in pediatric heart transplant recipients

Chronic Hypoxemia in the Newborn Lamb: Cardiovascular, Hematopoietic, and Growth Adaptations

Decreased serum insulin-like growth factor-I associated with growth failure in newborn lambs with experimental cyanotic heart disease.

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