A clinical consensus paper on jejunal tube feeding in children.

BACKGROUND: Feeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support. METHODS: A multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine consensus. RESULTS: A total of 24 consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow-up, and reassessment. CONCLUSION: Jejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow-up.

Establishing a disability-specific home enteral nutrition service in a paediatric tertiary hospital: Experience and outcomes.

AIMS: The provision of Home Enteral Nutrition (HEN) is a well-established support for patients, however, significant inconsistencies in funding result in financial burden for some healthcare services across Australia. Recent government-initiated funding changes prompted the development of a new HEN service for eligible patients with a disability, moving from a universal to more individualised approach to care. METHODS: This retrospective observational study included patients enrolled on a newly established disability-specific HEN service at a paediatric tertiary hospital between July 2020 and February 2022 inclusive. Components of service development were explored including service model, clinical resources, information related to patient enrolments and costings for annual HEN requirements provided by dietitians. Retrospective quantitative data was collected from the Electronic Medical Record system and analysed using descriptive statistics. RESULTS: A total of 362 patient enrolments occurred over a 21-month period, with an average of 17 new patients having accessed the service each month. Annual HEN supports were quoted at a median cost of $13487.94 AUD (2364.97-44170.92), mostly attributable to consumable requirements. Most eligible participants chose to receive care through the new HEN service. Supports were quoted >330% higher than previous fixed price allocations, highlighting the true cost associated with HEN care. Large variation in costings may be attributed to the diversity and complexity of patients. CONCLUSION: Funding changes presented a unique opportunity to meet pre-existing resource deficits and enabled individualised access to HEN supports for paediatric patients with a disability.

Neonatal dietitian resourcing and roles in New Zealand and Australia: A survey of current practice.

AIM: Dietitian-led implementation of evidence-based nutrition support practices improves nutrient intakes, clinical outcomes and growth, decreases length of stay and related costs, and reduces intravenous nutrition costs and prescription errors. We aimed to investigate current neonatal dietitian resourcing and roles in New Zealand and Australian neonatal units, and to compare this with dietitian workforce recommendations and previously reported survey data. METHODS: A two-part electronic survey was emailed to 50 Australasian Neonatal Dietitians Network members and other dietitians working in neonatal intensive care or special care baby units in New Zealand and Australia. The survey ran from July to October 2018. Descriptive statistics were used to examine the distribution of responses. Responses were compared with other similar surveys and British Dietetic Association workforce recommendations. RESULTS: There was an 88% response rate for Part 1. Forty-eight percent of respondents had worked in neonatology for more than 5 years. Ward rounds were attended weekly or more often by 43% of respondents. One-third regularly attended neonatal conferences or grand rounds. The majority spent less than 25% of their neonatal service allocation on teaching, developing policy or research. All respondents reported their unit had written enteral feeding guidelines. The neonatal dietitian workforce is at 23% of recommended levels. CONCLUSIONS: Australasian neonatal dietitians have great potential to add value in neonatal units which has not yet been fully realised. Funding reallocation, upskilling and on-going professional development are needed to ensure the neonatal dietitian workforce is at the recommended level to be safe, sustainable and effective.