Impact of exclusive enteral nutrition on the gut microbiome of children with medical complexity.

BACKGROUND: Children with medical complexity (CMC) often require enteral tube feedings to meet their nutrition needs. Many, however, experience symptoms of feeding intolerance, such as vomiting and pain. The goal of this analysis was to examine the relationship between diet and the gut microbiome, controlling for medications, among CMC receiving enteral tube feedings, CMC consuming oral nutrition, and healthy controls. Given the variety of available commercial formula preparations, we were also interested in examining the impact of different formula types on the CMC microbiome. METHODS: Fecal samples from 91 children (57 CMC and 34 healthy controls) were collected and analyzed. Parents completed clinical and dietary questionnaires. 16S ribosomal RNA amplicon sequencing was completed using the QIIME2 pipeline. RESULTS: A significant decrease in alpha diversity among CMC receiving exclusive enteral nutrition (CMC EEN) compared with healthy controls (Shannon P = 0.006 and Faith's phylogenetic distance P = 0.006) was found that was not observed between CMC receiving oral nutrition and healthy controls. Significant differences in beta diversity were also observed between CMC EEN and healthy controls, with CMC EEN having a greater relative abundance of Enterobacteriaceae and obligate anaerobes. Differences were also noted between CMC EEN and CMC receiving oral nutrition (Aitchison distance P = 0.001); however, no differences were observed between CMC receiving oral nutrition and healthy controls. CONCLUSION: Despite similarities in medication profiles, CMC EEN have decreased alpha diversity and differences in beta diversity compared with healthy controls not observed in CMC receiving oral nutrition, highlighting the impact of diet over medications.

Construção e validação de conteúdo de instrumento de coleta de dados em unidade neonatal / Construction and validation of data collection instrument content in a neonatal intensive care unit

Para possibilitar um levantamento de dados sistematizado, o estudo objetivou construir e validar um instrumento de avaliação clínica para neonatos internados em Unidade de Terapia Intensiva. Estudo metodológico realizado durante os meses de janeiro a junho de 2008. Este foi organizado em duas fases: levantamento bibliográfico para subsidiar a construção do instrumento e avaliação da adequação do conteúdo por especialistas do Estado do Ceará. O instrumento foi composto por dez seções: dados pessoais da mãe e recém-nascido, sinais vitais, integridade física/cutâneo-mucosa, cabeça/pescoço, avaliação dos sistemas: nervoso, respiratório, cardiovascular, gastrintestinal, geniturinário e binômio mãe-filho. Foram inclusos diagnósticos de enfermagem pertinentes para cada seção. Todas as seções foram consideradas adequadas. Quatro seções receberam escore máximo de concordância, sendo estas: dados pessoais da mãe e recém-nascido, cabeça/pescoço, sistema cardiovascular e sistema geniturinário. Acredita-se que a implementação deste instrumento poderá contribuir para que enfermeiros identifiquem indicadores que refletirão possíveis diagnósticos de enfermagem.