Unexpected Poor Growth in Pediatric Patients on Food‐based Enteral Therapy

Self Cite

BackgroundThere has been a renewed focus on offering commercial formulas made with real‐food ingredients because of their perceived health benefits, such as improved feeding tolerance and gut health. Children receiving enteral nutrition through these formulas often are fed via feeding pumps. Because these formulas vary in thickness, we aimed to explore the relationship between formula thickness and prescribed formula delivery via feeding pumps. We hypothesized that inaccurate volumes of commercial blenderized formula (CBF) are delivered via feeding pumps and that these inaccuracies are directly proportional to the thickness of the formula.MethodsWe performed International Dysphagia Diet Standardisation Initiative (IDDSI) tests for six de‐identified CBFs. We then ran these formulas over three feeding pumps using nasogastric and gastric tubes and simulated continuous and bolus feeds. We calculated the difference between programmed volume and actual delivered volume.ResultsModerate and extremely thick formulas (IDDSI level 3–4) delivered a median of 22.5% less volume than programmed in the pump (P < 0.001). In addition, there was a 25.5% reduction in delivered volume for thick formulas compared with thin formulas. This occurred despite using the manufacturer's recommendations for suggested tube size.ConclusionThicker CBF can provide inaccurate volumes via feeding pumps, which may contribute to poor weight gain when children are switched to these formulas. Based on these findings, we recommend best practices for using these formulas. More studies are needed to investigate the best formula consistency to optimize delivery and caloric intake.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Murayi,

Evenson,

Verkin‐Siebert

et al. 2023

Self Cite

“…Some manufacturers indicate that commercial BTF can impact pump performance and accuracy. Therefore, clinicians must ensure that patients receiving commercial BTF via a pump receive the full amount of formula prescribed 3 . The specific pump manufacturer should be referenced when using both commercial BTF and prepared BTF.…”

Section: Section 1: Practice Recommendations For General Use Of Btfmentioning

confidence: 99%

Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition

Epp,

Blackmer,

Church

et al. 2023

Prior to the 1970s, blending food and liquids and putting them through an enteral access device (EAD) was the most common form of enteral nutrition (EN). However, in the 1970s, blenderized tube feedings (BTFs) became less popular due to the emergence of modern commercial enteral formulas (CEFs). Recently, a cultural shift toward consuming a natural diet, consisting of whole foods, has led to a resurgence in the use of BTF. The increasing use of BTF in a variety of patient care settings identifies a need for practice recommendations that provide guidance for nutrition professionals and patients. Members of the American Society for Parental and Enteral Nutrition (ASPEN) Enteral Nutrition Committee identified salient clinical questions concerning BTF, conducted a comprehensive literature search, and subsequently developed practice recommendations pertaining to the use of BTF. This paper was approved by the ASPEN 2022–2023 Board of Directors.

“…A case series of children who grew poorly because of flow of commercial blenderized formulas through pumps has been published. 20 In addition, moderately and extremely thick commercial blended formulas flowed very poorly through feeding pumps. 21 These are certainly worse in home-blenderized feeds because of inconsistencies in the way the food is blended.…”

Section: Safety With Home-made Blenderized Feedsmentioning

confidence: 99%

“…There is also an incipient concern that these formulations are very thick and may not flow through enteral tubing systems particularly when children are fed via pumps. A case series of children who grew poorly because of flow of commercial blenderized formulas through pumps has been published 20 . In addition, moderately and extremely thick commercial blended formulas flowed very poorly through feeding pumps 21 .…”

Section: Introductionmentioning

confidence: 99%

Current topics in pediatric enteral nutrition safety

Murayi,

Goday

2023

Enteral nutrition is a cornerstone of nutrition support therapy in patients of all ages and across the care continuum. Safe delivery of enteral nutrition to patients is paramount. This review article will focus on current topics in enteral nutrition safety primarily in children including safety with home‐made blenderized feeds, recent infant and enteral formula shortages largely due to formula contamination at the manufacturer level, and concerns with importing infant formulas.