Early Enteral Nutrition in Children With Acute Pancreatitis.

Nutrition is an integral part of acute pancreatitis (AP) management and is not adequately studied in pediatrics. The goal from the present study was to evaluate the effect of nutrition and fat content on the length of stay and pain severity in patients with AP. This is a retrospective review of our nutrition database between May 1, 2014 and December 1, 2014. Pain levels were similar between patients who were allowed to feed and patients kept nill per os. Higher fat intake grams per kilogram per day was associated with significantly lower pain scores. Early feeds are feasible in pediatric patients with AP. Pain was not increased in the group that had more fat in their diet.

Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision-Making and Practice.

BACKGROUND: Tube feeding via nasogastric tubes (NGTs) and gastrostomy tubes (GTs) is a common practice for children unable to meet their nutrition needs by oral feeding alone. There is currently a lack of evidence-based guidance specific for the process of transitioning from an NGT to GT as a longer-term enteral access device. Uncertainty in the literature about feeding tube choices, practices, and transitions requires clinicians to draw on incomplete and sometimes conflicting evidence, personal experience, economic realities, and compassion to deliver supportive child-centered care. METHODS: The ASPEN Enteral Nutrition Task Force Pediatric Work Group designed a survey to explore current practice of enteral access device safety and use among pediatric clinicians practicing in the US and Canada. The survey aimed to define time frames, parameters, and decision points to guide clinicians and families in the transition from NG to GT feeding. RESULTS: 258 clinicians, 55% practicing in an inpatient setting, 17% in-home patient setting, and 28% practicing in both inpatient and outpatient setting. 22% were physicians, 42% were dietitians, 32% were nurses or advanced practice nurses, 2% were pharmacists. The most common feeding tubes used were NGTs followed by GTs. Majority of respondents indicated that they did not have a specific timeline for when an NGT should be changed to a GT. Highest ranked patient factors or clinical considerations prior to recommending changing from an NGT to a GT were exceeding the duration for temporary feeding or the need for an extended duration of tube feeding. Highest physician barriers to GT placement were the reluctance for referral from primary care doctors for GT placement. Majority of respondents reported the use of NGTs for enteral access at home and that parents were taught how to place the NGTs for home use but without consistently being taught the use of pH paper to verify NGT tip location or being provided with the pH paper to perform this task at home. CONCLUSIONS: This survey is the first step to address the knowledge gap surrounding feeding tube choices by ascertaining the current standard of practice regarding enteral access devices and appropriate timing of transitioning from NGT to GT feeding. The results highlight current practice variability and concerns. Information from the survey was used to formulate a decision tree to guide the transition of NGT to GT feeding that nutrition support professionals can use to advocate for best practices in their hospital and community settings.

Biomechanical investigations of the secondary stability of commercial short dental implants in porcine ribs.

The use of short implants has increased widely within the last years. However, the stability of these implants has not yet been comprehensively investigated, in particular the difference in geometry and dimension of short implants. The aim of the present study was to investigate experimentally the difference of the secondary stability of different commercial short implants by measuring their displacements. Eleven implant geometries were investigated in this study. A total of 22 implants were inserted in porcine rib segments, two implants for each system. Implant displacements were measured using a self-developed biomechanical hexapod measurement system (HexMeS). The highest displacement was observed with Straumann BL NC 3.3×8.0 mm (266 µm), followed by Straumann Standard 4.1×6.0 mm (156 µm), while the lowest displacement of 61 µm was shown by Dentaurum type 1 implant (4.2×5.0 mm). No obvious difference of displacements was observed between hammered and screw-shaped implants with relevant dimensions. The experimental results were in good agreement with the numerical ones (19-42%) for Dentaurum implants. However, a difference of 70-80% was obtained for the Astra implant (4.0×6.0 mm) and Bicon implant (6.0×5.7 mm). The geometry of short implants directly affects their stability within the bone.