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Care of the Hospitalized Child
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Anushree Algotar, Anna Tuttle, Mark R. Corkins
Certain clinical conditions such as aspiration and functional or mechanical gastric outlet obstruction necessitate post-pyloric feeding. Post-pyloric feeds can be provided via nasojejunal (NJ) or surgically placed long-term enteral access devices such as gastrojejunal (GJ) or jejunostomy (J) tubes. Nasoenteral devices may be placed at bedside but are most commonly placed with fluoroscopic assistance. Proper positioning needs to be confirmed prior to use, especially if placed at bedside. Position of the tube should also be confirmed on an ongoing basis. Potential issues include inadvertent dislodgement, blockage, and misplacement of the device. Surgically placed enterostomy tubes are also prone to dislodgement and rarely can cause intestinal obstruction.
International Practice Patterns in NEC Management
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Maarten Janssen Lok, Carlos Zozaya, Sinobol Chusilp, Agostino Pierro
Surgical procedures for performing laparotomy vary and are mostly chosen according to severity of disease and clinical condition of infants with NEC (13). The most common surgical procedure for NEC in North America is bowel resection with enterostomy (35). Conversely, in the UK and Europe, surgeons tend to rely more on resection and primary anastomosis (36). A multicenter randomized trial (STAT trial) is currently in progress to evaluate which procedure is most advantageous: enterostomy or primary anastomosis. The results from an international survey revealed that bowel resection with primary anastomosis are typically performed in NEC with a single perforation or single area of necrosis (13). For multiple perforations or multiple areas of necrosis, surgeons prefer to perform bowel resection with enterostomy more than primary anastomosis. In case of panintestinal NEC, the most preferable procedure is second-look laparotomy; the second is diverting jejunostomy, followed by the “clip and drop” technique, which consists of resection of grossly necrotic intestine, application of vascular clips to retain possibly viable bowel and second-look laparotomy after approximately 48 hours, diverting jejunostomy, and closure of the abdomen without carrying out any procedure (13). Others have advocated leaving the abdomen open using a silo, which affords for ongoing examination of bowel viability and reduces any intraabdominal pressure that may be contributing to bowel ischemia.
Meconium ileus
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Robert J. Vandewalle, Frederick J. Rescorla
Neonates with complicated meconium ileus are managed in a similar manner to uncomplicated cases, although return of bowel function may be somewhat slower, particularly in cases of perforation. Some infants may require total parenteral nutrition if bowel function is slow to return, or if a proximal enterostomy does not provide an adequate absorptive surface to support the infant with enteral nutrition alone. Infants with both a proximal and distal stoma can often be managed with oral feeds combined with refeeding of the proximal ostomy effluent into the distal stoma. Enterostomy closure is generally performed 5–6 weeks after the initial procedure.
Nutritional Support in Older Patients with Esophageal Cancer Undergoing Chemoradiotherapy
Published in Nutrition and Cancer, 2022
Diğdem Doğan Akagündüz, Perim Fatma Türker
While convenient, economical, and noninvasive, Nasogastric and nasojejunal enteral feeding leads to nasopharyngeal ulcers, catheter obstruction, and bleeding, which can be seen more frequently. After each infusion, the tube should be rinsed with normal saline to prevent blockage. Patients with nasogastric feeding tubes have a relatively poor quality of life due to pain. For patients requiring more than 30 day of tube feeding, a PEG/PEJ tube is considered more appropriate. The PEJ is suggested because it reduces the risks of aspiration during feeding in individuals with reflux or those at high risk of aspiration (28). PEG/PEJ has complications, including wound infection, minor bleeding, necrotizing fasciitis, and peritonitis (29). Surgical gastrostomy or jejunostomy becomes the available option because of the impossibility of performing gastroscopy to place PEG/PEJ due to complete blockage of the lumen by the massive primary tumor, technical failure of PEG/PEJ, and unavailability. On the other hand, surgical gastrostomy or enterostomy seems to have the disadvantage of needing a second laparotomy, which usually delays the start of radiotherapy by 1–2 weeks (30).
Current strategies for managing intestinal failure-associated liver disease
Published in Expert Opinion on Drug Safety, 2021
Jordan D Secor, Lumeng Yu, Savas Tsikis, Scott Fligor, Mark Puder, Kathleen M Gura
In PN-dependent infants (particularly those with surgical SBS), breast milk may improve intestinal adaptation, hasten time to full enteral feeding, and decrease risk of IFALD [1,71]. Medical and surgical therapies to improve tolerance of EN are largely beyond the scope of this review. Teduglutide, a glucagon like peptide 2 (GLP-2) analog that promotes growth and adaptation of the intestinal mucosa, decreased PN requirements and liver enzymes and bilirubin compared to placebo in a randomized controlled trial [72]. Non-transplant surgery may also be beneficial. Restoring gastrointestinal continuity through enterostomy reversal (or primary anastomosis) improves absorptive capacity and may improve weaning from PN [73]. In a small study of PN-dependent adults with chronic cholestasis following bowel resection for a mesenteric infarction, restoring bowel continuity resulted in half of patients returning to normal liver tests [74].
Risk factors and predictive model for abdominal wound dehiscence in neonates: a retrospective cohort study
Published in Annals of Medicine, 2021
Shouxing Duan, Xuan Zhang, Xuewu Jiang, Wenhui Ou, Maxian Fu, Kaihong Chen, Xinquan Xie, Wenfeng Xiao, Lian Zheng, Shuhua Ma, Jianhong Li
It has been reported that the incidence of wound dehiscence after infection is 5–10 times as high as that after primary healing [11]. It has been noted that infection is an important cause of wound dehiscence. In the group of neonates included in the current study, contaminated incisions (types II and III) accounted for 92.6% (25/27) of AWD cases. The chances of contamination of the surgical field are higher than in aseptic surgery. The incidence of incision dehiscence increases with an increase in the degree of contamination. All 5 cases of complete wound dehiscence had undergone intestinal tract surgery, and all of them received more than a type II incision. In 2 cases of enterostomy, the stoma was placed at the original wound made during the first surgery, and the intestinal fluid contaminated the wound and caused infection; in 1 case of congenital intestinal malrotation, the second abdominal exploration showed that the thread used to ligate the appendix became loose, and pus was found in the abdominal cavity; and in the other 2 patients, the abdominal cavity was contaminated by faeces. Contamination occurred in the above-mentioned patients, indicating that wound contamination is an important risk factor for AWD. There was a positive correlation between the incision type and AWD, and the incidence increased with the aggravation of contamination.