Monitor gastrointestinal tolerance in children who have switched to an “enteral formula with food‐derived ingredients”: A national, multicenter retrospective chart review (RICIMIX study)

Abstract

Background Enteral tube feeding intolerances, such as diarrhea, are commonly reported in children. In the pediatric population, interest is growing in the use of blended diets for the management of enteral feeding intolerances. Fiber within a blended diet stimulates the growth of beneficial gut bacteria, which in turn produce short‐chain fatty acids, which are utilized as energy substrates for enterocytes. Enteral formula manufacturers have responded to this trend towards “real‐food” blended diets and developed an enteral formula with food‐derived ingredients. The aim of this study was to collect data relating to feed tolerance in children who had switched to an “enteral formula with food‐derived ingredients.” Methods A national multicenter retrospective study. Results Dietitians collected data from 43 medically unwell children between March 2021 and July 2021. Significant improvements were reported in children who had switched to an “enteral formula with food‐derived ingredients” in retching 17 of 18 children (95%), flatulence 6 of 8 children (85%), loose stools 10 of 11 children (90%), and constipation 10 of 11 children (90%). These improvements in gastrointestinal symptoms were reflected in weight change during the one month period measurements were collected (baseline, 19.5 kg [SD, 9]; 1 month, 20.1 kg [SD, 9]; P = 0.002). Conclusion We have observed beneficial outcomes in medically complex children who have switched to an “enteral formula with food‐derived ingredients.” Our data should motivate healthcare professionals to implement more research to better evaluate the clinical impact and mechanisms of action of blended diets and enteral formulas with food‐derived ingredients.

Understanding the use and tolerance of a pediatric and an adult commercial blenderized enteral formula through real‐world data

“…7,16 A recent, multicenter, retrospective study of 43 children who were medically unwell found improvements in GI symptoms when participants switched to an enteral formula based on realfood ingredients. 9 Similarly, a prospective, observational study of 21 children with neurological impairments who switched to a 1.0 kcal/ml real-food formula reported that calorie and protein goals were achieved without intolerance or serious adverse events. 15 Another study examined a lowcalorie real-food formula in 16 hypometabolic pediatric patients with neurological impairments or neuromuscular disorders, who would traditionally receive standard enteral formulas manipulated with modular protein, vitamins, minerals, and water.…”

“…3,18 Frequently, clinicians use the presence of upper and lower GI symptoms to help assess formula tolerance. 9,17 In a recent Canadian study, GI-related complications of HEN (including nausea and vomiting, abdominal pain, constipation, and diarrhea) occurred in…”

“…The past decade has seen a resurgence in the use of homemade blenderized formulas, with caregivers wishing to customize the nutrition they can provide, focusing on natural, organic whole foods and eliminating specific foods to support individuals with allergies or intolerances. 8,9 Commercial formula manufacturers have responded to requests for blended formulas that are nutritionally consistent, made with whole foods, and offer convenient use. [8][9][10][11] However, real-world usage and tolerance of these new commercial blenderized enteral formulas (CBEFs) have rarely been evaluated and reported in the literature.…”

“…8,9 Commercial formula manufacturers have responded to requests for blended formulas that are nutritionally consistent, made with whole foods, and offer convenient use. [8][9][10][11] However, real-world usage and tolerance of these new commercial blenderized enteral formulas (CBEFs) have rarely been evaluated and reported in the literature.…”

Facilitating open discussions New guidelines for paediatric blended diets

“…A more recent retrospective, multi-centre study also explored the benefits of Compleat ® paediatric (O'Connor et al, 2021). The authors collected data from 43 tube-fed children.…”