The PRISMA flowchart was used (Fig. In studies where continuous NG was provided, YP were sometimes not given the option of an oral diet so that their calorie intake could be closely monitored [22,23,24, 31]. Results have shown that NG feeding is used commonly in the hospital setting to treat medical instability as a result of severe malnourishment, and in the specialist eating disorders (ED) unit due to failure to meet oral intake. In other words, the lower a patients weight, the higher their risk for this complication during refeeding. Results interpreted from studies with a high risk of bias were removed accordingly, leaving only high quality results and conclusions. 1 Malnourished 2010;46(6):57782. London: National Institute for Health and Care Excellence (UK); 2017. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. 8600 Rockville Pike https://doi.org/10.1097/00004703-200412000-00005. Alternative causes of hypophosphatemia are listed here: Thiamine 200-500 mg IV q8hr-q12hr (use higher dose in the context of any mental status changes, which could reflect the possibility of Wernicke encephalopathy). Agostino H, Erdstein J, Di Meglio G. Shifting paradigms: continuous nasogastric feeding with high caloric intakes in anorexia nervosa. It is evident that there is a wide variety of practices regarding implementation and regime of NG feeding in YP with eating disorders globally [9]. None developed clinical RFS. Halse C, Broughtwood D, Clarke S, Honey A, Kohn M, Madden S. Illumating multiple perspectives: meaning of nasogastric feeding in anorexia nervosa. By using this website, you agree to our CR168s Summary of Junior Marsipan: Management of really sick patients under 18 with Anorexia Nervosa. Heres How Much Protein You Need in a Day to Build Muscle, changes in fat, glucose, or protein metabolism. Int J Eat Disord. Int J Eat Disord. This review describes the large differences in the use of NG for YP with ED in medical and psychiatric wards in a number of countries globally. Int J Mental Health Nursing. government site. Three studies were qualitative interview studies, examining patient or staff feelings towards NG feeding in practice which increases the risk of confirmation bias. Nasogastric feeding (NG) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement poor oral intake or to increase nutritional intake. Routine NG feeding may allow greater initial caloric intake, which does not increase risk of medical complications, and may actually increase initial weight gain thus reducing time in hospital. WebIv or oral multivitamins once daily for 10 days or greater based on clinical status Emad Zarief 2021 29 ASPEN Consensus recommendations for refeeding syndrome. As early RFH might impact recovery, it is important to closely monitor phosphate concentrations in patients, especially of those at risk for early RFH. Aggressive repletion of electrolytes, with the exception of calcium (IV calcium may exacerbate hypophosphatemia). National Institute for Health and Clinical Excellence. Inclusion terms were: enteral feeding by nasogastric tube, under 18years, eating disorders, and primary research. Symptoms of refeeding syndrome may include: These symptoms typically appear within 4 days of the start of the refeeding process. Here are the 12 best vegan protein powders. Maginot et al., 2017 [18] and Whitelaw et al., 2010 [9] reported NG bolus feeding in 13.8 and 15% in order to supplement oral diet with a mean weight gain of 3.1kgs and 2.6kgs respectively but did not report if this was specific to NG feeding. Short-term outcomes of the study of refeeding to optimize inpatient gains for patients with anorexia nervosa: a multicenter randomized clinical trial [published online ahead of print October 19, 2020]. Additionally, the combination of plasma butyric acid levels and HIF3A intron 1 methylation at CpG 6 discriminated DCM patients from type2 diabetes mellitus (T2DM) patients. A systematic review of enteral feeding by nasogastric tube in young people with eating disorders, https://doi.org/10.1186/s40337-021-00445-1, https://www.ncbi.nlm.nih.gov/books/NBK436876/, https://doi.org/10.1136/bmjopen-2018-027339, https://doi.org/10.1016/j.encep.2012.06.001, https://doi.org/10.7326/0003-4819-102-1-49, https://doi.org/10.1016/j.jadohealth.2009.11.207, https://doi.org/10.1186/s40337-016-0132-0, https://doi.org/10.1177/0148607106030003231, https://doi.org/10.1097/00004703-200412000-00005, https://doi.org/10.1017/S0033291714001573, https://doi.org/10.1016/j.jadohealth.2013.06.005, https://doi.org/10.1186/s40337-015-0047-1, https://doi.org/10.12968/bjmh.2019.8.3.124, https://doi.org/10.1136/archdischild-2016-310506, https://doi.org/10.1080/10640260902991236, https://doi.org/10.1007/s40519-018-0572-4, https://doi.org/10.24953/turkjped.2016.06.010, https://doi.org/10.1002/1098-108X(200012)28:4<470::AID-EAT18>3.0.CO;2-1, https://doi.org/10.1176/appi.ajp.159.8.1347, https://doi.org/10.5694/j.1326-5377.2009.tb02487.x, https://doi.org/10.1007/s00787-008-0706-8, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. https://doi.org/10.1155/2016/5168978. Treatment usually involves replacing essential electrolytes and slowing down the refeeding process. Kezelman and colleagues (Australia) 2018 [26] assessed the impact on anxiety, depression and ED symptoms when using NG in adjunct to oral intake as part of a rapid refeeding regime. But this treatment may not be suitable for people with: In addition, fluids are reintroduced at a slower rate. Naso-gastric or nasogastric or *enteric or *enteral or tube, (Anorexia or bulimia or eat* or feed*) NOT bowel NOT surgery NOT intestin*, (child* or paed* or adolescen* or teen* or young) NOT baby NOT toddler NOT infant NOT animal NOT maternal NOT parental NOT learning disabl* NOT learning disabil*. However, refeeding is also a critical component to recovery and NG feeding will often be utilised if a young person has been unable to manage oral intake in order to prevent signs of physical unwellness [9, 10]. Front Psychol. Many sources recommend starting conservatively (e.g., 50% energy requirement), with gradual advancement. Van Noort BM, Lohmar SK, Pfeiffer E, Lehmkul U, Winter SM, Kappel V. Clinical characteristics of early onset anorexia nervosa. Webreport, literature review and clinical guidelines. Nutr Clin Prac. https://doi.org/10.1136/archdischild-2016-310506. Key studies were manually reviewed for additional research, but none were identified that were not already included, 1 eligible study was identified through peer review. 2018;51(11):121322. AustralasPsychiatry. Our unpublished survey of doctors, nurses, pharmacists, and dietitians (all members of their respective nutrition societies) on their attitudes to the guidance from the National Institute for Health and Clinical Excellence (NICE)2 showed widespread disparities in practice. The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe Article 69.) 2006;163(7):454. Due to the anticipated paucity of studies in this area any research where a meaningful conclusion or result can be drawn regarding NG use in YP with ED will be included. Family-based treatment (FBT) is a psychotherapy shown to be effective in a number of randomized controlled trials in physically stable patients with anorexia nervosa (AN), under the age of 19, and within 3 years of illness. The .gov means its official. The evolution of all aspects of HPN is presented. Monitor electrolytes carefully. Rizzo SM, Douglas JW, Lawrence JC. Percent of BG hours in the 4.48.0mmol/L range highest under standard STAR conditions (78%), and was lower at 64% under UL-9, likely due to reduced time-responsiveness of nutrition-insulin changes. Later, diagnostic criteria and algorithms for the RFS diagnosis based on both electrolyte abnormalities and clinical manifestations have been proposed [5,10,11]. Nehring and colleagues [37] concluded that NG feeding had no impact on growth, recovery or development of psychiatric co-morbidities. Clausen L, Larsen JT, Bulik CM, Peterson L. A Danish register-based study on involuntary treatment in anorexia nervosa. NG feeding may be administered through different methods such as continuously, multiple single meals (bolus), or overnight to supplement day-time oral intake. This definition is somewhat unique in its incorporation of potassium and magnesium changes. 1, 2 Its principles regard the family as the best treatment resource for recovery, hospitalization as a temporary solution, and PubMed, Embase, Cochrane Library, Web of Knowledge, and two Chinese databases were systematically searched until October 2021. 2019;24(2):17998. References were exported and duplicates were removed using the title and abstract. We therefore advocate septic screening and a low threshold for broad spectrum antibiotic cover for any patients with unexplained hypothermia, hypoglycaemia, and evidence of malnutrition. and transmitted securely. https://doi.org/10.1007/s40519-018-0572-4. (2001). https://doi.org/10.1002/eat.22968. Structured, supported feeding admissions for restrictive eating disorders on paediatric wards. Refeeding syndrome is a severe complication of refeeding in people with malnutrition, it includes a series of electrolyte disorders and clinical symptoms. Previous studies indicate that the incidence of refeeding syndrome is relatively high [12], including electrolyte abnormalities with sodium-water retention, which may potentially lead to heart and respiratory failure, even death [11,13,14]. Only 52% of studies were conducted prospectively. AHRQ publication no. Terms & Conditions | Privacy Policy, Read recovery stories from ACUTE patients, See the latest research about conditions treated at ACUTE, Refeeding Syndrome Symptoms and Warning Signs, The Impact of Food Restriction on the Body, Endocrine Dysfunction in Anorexia Nervosa Patients, Complications from the Misuse of Laxatives and Diuretics, Avoidant Restrictive Food Intake Disorder (ARFID). Evidence report/technology assessment no. See, treatment of established refeeding syndrome, Treatment of established refeeding syndrome, https://traffic.libsyn.com/secure/ibccpodcast/IBCC_EP_83_-_Refeeding_Syndrome.mp3. Robb AS, Silber TJ, Orwell-Valente JK, et al. 27 patients were enrolled. Learn the difference between these two conditions. When NG feeding is used under restraint bolus feeds are preferred due to concerns around the tube being removed by the YP once restraint had ceased [45]. official website and that any information you provide is encrypted National Collaborating Centre for Mental Health. Together, these processes can lead to decreased concentrations of minerals in the blood, of which hypophosphatemia is the most characteristic [14]. Furthermore, no relevant association to lengths of stay in intensive care or hospital were detected. Prior to 2017, St Georges Hospitals refeeding guidelines (Figure 2/Figure 3) were not in line with NICE's Nutrition Support for Adults guidelines (CG32). This audit included patients from January November 2017 whereby 51 patients were identified as high risk or extremely high risk and 3 were classed as at risk. To overcome this challenge, a new statistical approach is proposed in this study: analyzing the linear association of computer tomography derived muscle parameters with important clinical short- and long-term outcomes post esophagectomy, regardless of cut-offs. 2016;101(9):8368. Fuller S, Street O, Hudson L, Nicholls D. Enteral feeding young people with anorexia nervosa under restraint in inpatient settings. 2000;28(4):4705. Nutr Clin Pract. Predictive factors of length of inpatient treatment in anorexia nervosa. 1). A systematic review of approaches to refeeding in patients with anorexia nervosa. (2) Hypophosphatemia which occurs within three days of refeeding. 2014;48(11):9771008. Electrolyte levels are monitored with frequent blood tests. Gradual initiation of nutrition for the highest risk patients. A retrospective analysis of all medical records of HPN patients from the University Hospital and Stanley Dudrick's Memorial Hospital in Skawina. Dysphagia or hyperemesis. This systematic review sets out to review the current reported evidence of NG in young people. 2023 Healthline Media LLC. In the circumstances that their BMI is detrimentally low, a nasogastric (NG) tube may be placed from nose to stomach to pass nutrition. Less time spent being underfed may still result in refeeding syndrome if the patient were under, Abuse, neglect, inadequate access to food, Hyperemesis gravidarum or protracted vomiting, Malabsorption (e.g., inflammatory bowel disease, short gut syndrome, s/p bariatric surgery). The study aims at identifying clinically available variables predictive of EGP and GNG magnitude by modeling routinely available data. 73 (12.04%) were successfully weaned off PN. J Eat Disord 9, 90 (2021). To keep this page small and fast, questions & discussion about this post can be found on another page here. Ichimaru S. Methods of enteral nutrition Administration in Critically ill Patients: continuous, cyclic, intermittent, and bolus feeding. A retrospective design also creates selection bias as those lost to follow up are not considered. 1985;102(1):4952. As per NICE guidelines, the care plan developed for each patient should specify how the patient will be discharged and reenter community-based care. At day 10, VO2 (R=0.59, P=0.04) was correlated with GNG and VCO2 with EGP (R=0.85, P=0.00003). A blood test has revealed your serum phosphate, potassium, or magnesium levels are low. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The catheter infection rate reached 0.39/1000 catheter days. Background The incidence of refeeding syndrome (RFS) in critically ill patients is high, which is detrimental to their prognoses. Skeletal muscle index (SMI), quantifying muscle mass, was assessed with computed tomography (CT) in 98 patients undergoing esophagectomy. Youve lost more than 15 percent of your body weight in the past 3 to 6 months. 2020;29(6):118191. According to these guidelines, patients at the highest risk for refeeding syndrome meet one or more of the following criteria: Patients with anorexia nervosa or ARFID may also have significant risk for refeeding syndrome if they meet two or more of the following criteria: In addition, chronic alcoholism, cancer, uncontrolled diabetes or recent surgery may place a patient with anorexia at elevated risk for developing refeeding syndrome. Bethesda, MD 20894, Web Policies Early RFH occurred in 3% of critically ill children. When food is reintroduced, theres an abrupt shift from fat metabolism back to carbohydrate metabolism. Univariate, unadjusted long-term survival analysis revealed that lower MRA and lower SMI were associated with shorter survival (P=0.03). All authors have reviewed the document and consent to publication. Although complications such as electrolyte abnormalities did occur there was no evidence that this was attributable to the NG feeding compared to oral diet [9, 18, 23, 24]. Our study suggests more standardized methods of caloric intake are needed in resource-limited settings with high co-prevalence of PEM and TB. Paccagnella A, Mauri A, Baruffi C, Berto R, Zago R, Marcon ML, et al. An Australian study [45] (conducted in a paediatric unit) found YP viewed being NG fed as: an unpleasant experience, a necessary intervention, a psychological signifier of illness, and an emphasis in an underlying struggle for control. Skipper. For example, in Australian studies medical wards tended to include high levels of psychiatric treatment alongside medical treatment [26]. Most studies tailored the calorie requirements to the individual patient, accounting for initial weight for height percentage and signs of medical instability. No ethical approval or consent to participate required due to the nature of the study. https://doi.org/10.1002/erv.2614. The refeeding syndrome (RFS) is described as a set of metabolic and electrolyte alterations occurring as the result of the reintroduction of calories through oral, enteral, parenteral nutrition after a period of consistent reduction of energy intake or starvation in individuals with pre-existent malnutrition and/or in a catabolic state [[1], [2], [3]].
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