Intermittent feeding with an overnight fast versus 24-h feeding in critically ill neonates, infants, and children: An open-label, single-centre, randomised controlled trial

Veldscholte, Karlien; Cramer, Arnout B.G.; Jonge, Rogier C. J. de; Rizopoulos, Dimitris; Joosten, K.F.; Verbruggen, Sascha

doi:10.1016/j.clnu.2023.07.010

Cited by 5 publications

(6 citation statements)

References 28 publications

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“…ICU mortality: Only five out of nine studies reported ICU mortality outcomes. No statistically significant difference was observed in continuous and intermittent enteral feeding groups (OR: 0.66; 95% CI: 0.42 to 1.04; p=0.07; I 2 =0% {low heterogeneity}) (Figure 4) [12,[17][18][19][20]. Hospital mortality: Only three studies reported hospital mortality.…”

Section: Primary Outcomesmentioning

confidence: 99%

“…Hospital mortality: Only three studies reported hospital mortality. Similarly, there was no significant difference between continuous and intermittent enteral feeding groups (OR: 0.57; 95% CI: 0.31 to 1.03; p=0.06; I 2 =21% {low heterogeneity}) (Figure 5 ) [ 12 , 17 , 18 ].…”

Section: Reviewmentioning

confidence: 99%

“…However, no study included in this meta-analysis found significant differences in these outcomes. Veldscholte et al focused on critically ill children and concluded that condensed feeding periods during the day did not lead to increased feeding intolerance [ 18 ]. However, intermittent feeding with an overnight fast resulted in lower calorie intake.…”

Section: Reviewmentioning

confidence: 99%

“…Performance bias was deemed high in seven studies, while two studies had an unclear risk of bias in this aspect. Only one study exhibited a high risk of bias in blinding of outcome assessment [4,12,[17][18][19][20][21][22][23].…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Both continuous and intermittent enteral feeding groups demonstrated no significant differences (OR: 0.48; 95% CI: -0.05 to 1.01; p=0.08). However, the heterogeneity was high (I 2 =61%) (Figure 6) [4,12,[17][18][19][20]. Hospital length of stay: Data from three studies was analyzed for hospital length of stay.…”

Section: Primary Outcomesmentioning

confidence: 99%

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Bolus Versus Continuous Enteral Feeding for Critically Ill Patients: A Systematic Review and Meta-Analysis

Abdelbaky,

Elmasry,

Awad

2024

Cureus

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Enteral feeding is a crucial aspect of nutritional support for critically ill patients. However, the optimal feeding approach, whether bolus or continuous, remains a subject of debate. This systematic review and meta-analysis aimed to compare the outcomes of bolus feeding and continuous enteral feeding in critically ill patients. A systemic search was carried out in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate, Web of Science, Scopus, and Google Scholar to identify relevant studies. To ensure that we obtain the latest evidence on the topic, the search was limited to the last five years. Risk of bias assessments and meta-analyses were performed for relevant clinical outcomes. A total of nine randomized controlled trials (RCTs) were included, involving a total of 863 patients. All the studies were published between 2020 and 2023. High-risk performance bias was observed in seven studies, with unclear risk in two studies. In terms of clinical outcomes, no statistically significant differences were found between bolus and continuous enteral feeding in terms of diarrhea (odds ratio {OR} 0.60, 95% CI 0.27 to 1.30, p=0.20), constipation (OR 1.52, 95% CI 0.91 to 2.53, p=0.11), vomiting (OR 0.74, 95% CI 0.36 to 1.49, p=0.39), distention (OR 0.70, 95% CI 0.14 to 3.58, p=0.66), aspiration (OR 0.61, 95% CI 0.16 to 2.73, p=0.48), and gastric residual volume (GRV) (OR 0.80, 95% CI 0.30 to 2.15, p=0.66). Furthermore, no significant differences between bolus and continuous feeding were observed in terms of intensive care unit (ICU) mortality (OR 0.66, 95% CI 0.42 to 1.04, p=0.07), hospital mortality (OR 0.57, 95% CI 0.31 to 1.03, p=0.06), ICU length of stay (OR 0.70, 95% CI 0.50 to 1.90, p=0.25), and hospital length of stay (OR -0.86, 95% CI -3.04 to 1.33, p=0.44). This systematic review and meta-analysis suggest that bolus and continuous enteral feeding methods exhibit comparable outcomes in critically ill patients. However, both ICU mortality and hospital mortality outcomes were close to achieving statistical significance, which favored the continuous feeding approach.

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Section: Primary Outcomesmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Primary Outcomesmentioning

confidence: 99%

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Bolus Versus Continuous Enteral Feeding for Critically Ill Patients: A Systematic Review and Meta-Analysis

Abdelbaky,

Elmasry,

Awad

2024

Cureus

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Plasma metabolomics changes comparing daytime to overnight infusions of home parenteral nutrition in adult patients with short bowel syndrome: Secondary analysis of a clinical trial

Dashti,

Sevilla-Gonzalez,

Mogensen

et al. 2024

Clinical Nutrition ESPEN

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Chrononutrition in Critical Illness

Sagun,

Akyol,

Kaymak

2024

Nutrition Reviews

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Circadian rhythms in humans are biological rhythms that regulate various physiological processes within a 24-hour time frame. Critical illness can disrupt the circadian rhythm, as can environmental and clinical factors, including altered light exposure, organ replacement therapies, disrupted sleep–wake cycles, noise, continuous enteral feeding, immobility, and therapeutic interventions. Nonpharmacological interventions, controlling the ICU environment, and pharmacological treatments are among the treatment strategies for circadian disruption. Nutrition establishes biological rhythms in metabolically active peripheral tissues and organs through appropriate synchronization with endocrine signals. Therefore, adhering to a feeding schedule based on the biological clock, a concept known as “chrononutrition,” appears to be vitally important for regulating peripheral clocks. Chrononutritional approaches, such as intermittent enteral feeding that includes overnight fasting and consideration of macronutrient composition in enteral solutions, could potentially restore circadian health by resetting peripheral clocks. However, due to the lack of evidence, further studies on the effect of chrononutrition on clinical outcomes in critical illness are needed. The purpose of this review was to discuss the role of chrononutrition in regulating biological rhythms in critical illness, and its impact on clinical outcomes.

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Intermittent feeding with an overnight fast versus 24-h feeding in critically ill neonates, infants, and children: An open-label, single-centre, randomised controlled trial

Cited by 5 publications

References 28 publications

Bolus Versus Continuous Enteral Feeding for Critically Ill Patients: A Systematic Review and Meta-Analysis

Bolus Versus Continuous Enteral Feeding for Critically Ill Patients: A Systematic Review and Meta-Analysis

Plasma metabolomics changes comparing daytime to overnight infusions of home parenteral nutrition in adult patients with short bowel syndrome: Secondary analysis of a clinical trial

Chrononutrition in Critical Illness

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