Breastfeeding Initiation by WIC Receipt After Formula Shortages in 2022.

This study assesses differences in breastfeeding initiation trends between Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants and WIC-eligible nonparticipants before, during, and after the 2022 infant formula disruption.

An Elemental Diet Reduces Chylous Ascites of Patients Undergoing Pancreatoduodenectomy in the Setting of Early Enteral Feeding.

OBJECTIVES: The elemental diet (ED) is a formula to support nutritional status without increasing chylous burden. This study evaluates the efficacy of early ED feeding after pancreatoduodenectomy (PD). MATERIALS AND METHODS: A prospective phase II study of consecutive patients who underwent PD with early ED feeding was conducted. Patient backgrounds, surgical outcomes, and ED feeding tolerability were compared with a historical cohort of 74 PD patients with early enteral feeding of a low residue diet (LRD). RESULTS: The ED group comprised 104 patients. No patient in the ED group discontinued enteral feeding because of chylous ascites (CAs), whereas 17.6% of the LRD group experienced refractory CAs that disrupted further enteral feeding. The CAs rate was significantly decreased in the ED group compared with the LRD group (3.9% and 48.7%, respectively; P < 0.001). There was no significant difference in the incidence of major complications (ED: 17.3%, LRD: 18.9%; P = 0.844). Postoperative prognostic nutritional index was similar between the 2 groups ( P = 0.764). In multivariate analysis, enteral feeding formula, and sex were independent risk factors for CAs (LRD: P < 0.001, odds ratio, 22.87; female: P = 0.019, odds ratio, 2.78). CONCLUSIONS: An ED reduces postoperative CAs of patients undergoing PD in the setting of early enteral feeding.

Emergent invariance and scaling properties in the collective return dynamics of a stock market.

A key metric to determine the performance of a stock in a market is its return over different investment horizons (τ). Several works have observed heavy-tailed behavior in the distributions of returns in different markets, which are observable indicators of underlying complex dynamics. Such prior works study return distributions that are marginalized across the individual stocks in the market, and do not track statistics about the joint distributions of returns conditioned on different stocks, which would be useful for optimizing inter-stock asset allocation strategies. As a step towards this goal, we study emergent phenomena in the distributions of returns as captured by their pairwise correlations. In particular, we consider the pairwise (between stocks i, j) partial correlations of returns with respect to the market mode, ci,j(τ), (thus, correcting for the baseline return behavior of the market), over different time horizons (τ), and discover two novel emergent phenomena: (i) the standardized distributions of the ci,j(τ)'s are observed to be invariant of τ ranging from from 1000min (2.5 days) to 30000min (2.5 months); (ii) the scaling of the standard deviation of ci,j(τ)'s with τ admits good fits to simple model classes such as a power-law τ-λ or stretched exponential function [Formula: see text] (λ, ß > 0). Moreover, the parameters governing these fits provide a summary view of market health: for instance, in years marked by unprecedented financial crises-for example 2008 and 2020-values of λ (scaling exponent) are substantially lower. Finally, we demonstrate that the observed emergent behavior cannot be adequately supported by existing generative frameworks such as single- and multi-factor models. We introduce a promising agent-based Vicsek model that closes this gap.

Identification of enteral nutrition errors in a single-center quality-improvement audit.

BACKGROUND: Enteral nutrition (EN) therapy is a multistep process including evaluation, prescription, procurement, dispensing, labeling, administration, and monitoring. EN therapy is prone to human errors, but these are poorly defined in the literature. The purpose of this study was to audit EN administration practices to quantify errors of execution and identify which components of the EN order were labeled, administered, or documented incorrectly. METHODS: On 2 nonconsecutive days, we identified all hospitalized patients with active EN orders and prospectively collected the following information: EN formula hanging/documented, formula hang time, infusion rate/documented rate (continuous EN), infused volume and documented schedule (intermittent EN), and EN modular documentation. Mismatches to the EN order were considered errors. We reviewed 1 month of hospital EN-related safety events for comparison. RESULTS: Of 1045 data points collected from 160 patients, we identified 275 errors of execution: 135 labeling errors and 140 administration errors. The most common were hang time >48 h (85%), wrong number of modulars documented (48%), and wrong infusion rate (19%). We found one reported safety event (wrong formula delivered but not infused). CONCLUSION: We identified a 15.9% error rate in EN order execution/documentation and 14% compliance with documentation of 48-h hang time. Errors (safety events) were grossly underreported. This highlighted several areas of opportunity to improve current EN use process, consistent with previous research on EN and oral nutrition supplement administration. Based on our findings, we plan to recommend implementation of EN barcoding at our institution, to model the familiar medication administration record.

Clinical outcomes associated with blenderized tube feedings in adults: A systematic review.

Nearly half a million individuals in the United States are dependent on enteral nutrition to meet their nutrition needs. Public interest in blenderized tube feeding (BTF) has increased over the past decade; however, medical professionals indicate a lack of knowledge about these products and their effects. The purpose of this review is to analyze clinical outcomes in adults who use a BTF formula as their primary nutrition source. A literature search was conducted in PubMed, Scopus, and CINAHL using search terms "adult," "enteral nutrition," "tube feeding," "BTF," blenderized," "blended," "homemade," and "pureed." Nine studies met the inclusion criteria and were analyzed in the review. Under close monitoring, BTF does not pose a higher risk for deterioration in anthropometric measurements. Furthermore, BTF use is consistently associated with improvements in diarrhea. As such, clinicians should consider the use of these formulas in the acute care or rehabilitation settings. Additional research is needed in patients with diverse clinical backgrounds in free-living communities. Larger populations sizes and longer intervention time frames are crucial to providing statistically significant results needed to strengthen the quality of evidence on this topic.

Breastfeeding and Once-Daily Small-Volume Formula Supplementation to Prevent Infant Growth Impairment.

BACKGROUND: Randomized controlled trials in Guinea-Bissau and Uganda have revealed that the intensive promotion of exclusive breastfeeding (EBF) impairs growth in early infancy. When newborn growth is impaired, small amounts of formula may be combined with breastfeeding to promote growth. METHODS: To determine if breastfeeding combined with once-daily formula supplementation improves growth among at-risk newborns, we conducted a pilot randomized controlled trial in Bissau, Guinea-Bissau and Kampala, Uganda. We randomly assigned 324 healthy breastfeeding newborns who weighed 2000 g to 2499 g at birth or <2600 g at 4 days old to once-daily formula feeding through 30 days as a supplement to frequent breastfeeding followed by EBF from 31 days through 6 months, or to EBF through 6 months. The primary outcome was weight-for-age z score (WAZ) at 30 days. Other outcomes included weight-for-length z score (WLZ), length-for-age z score (LAZ), breastfeeding cessation, adverse events, and serious adverse events through 180 days. RESULTS: Daily formula consumption in the intervention group was 31.9 ± 11.8 mL. The random assignment did not impact WAZ, WLZ, LAZ, breastfeeding cessation, adverse events, or serious adverse events through 180 days. In the intervention and control groups, 19 (12%) and 35 (21%) infants, respectively, reported nonformula supplementation in the first 30 days (P = .02). CONCLUSIONS: Once-daily formula supplementation for 30 days was well-tolerated, but the small volume consumed did not alter growth through 180 days of age. Further research would be required to determine if larger formula volumes, longer duration of treatment, or more frequent feeding are effective at increasing growth for this at-risk population.

Blenderized food tube feeding in very young pediatric patients with special healthcare needs.

BACKGROUND: Up to 85% of children with severe developmental disabilities have feeding disorders and require enteral tube feeding. Many caregivers desire blenderized tube feeding (BTF) instead of commercial formula (CF) for their child, citing a desire for a more physiologic feeding, to reduce gastrointestinal (GI) symptoms and/or promote oral intake. METHODS: In this retrospective, single-center study, medical records (n = 34) of very young children (aged ≤36 months) with severe developmental disabilities were reviewed. Comparisons of growth parameters, GI symptoms, oral feeding, and GI medication use were made between the initial introduction of BTF and again at the last patient encounter when the children aged out of the program. RESULTS: Of the 34 charts reviewed (16 male and 18 female patients), comparisons between baseline BTF introduction and the last patient encounter indicated reductions in adverse GI symptoms, significant GI medication reduction (P = 0.000), increased oral food intake, and nonsignificant improvements in growth parameters. These positive outcomes were realized whether children received full or partial BTF or type of BTF formulation. CONCLUSION: Consistent with similar research studies, transitioning very young children with significant special healthcare needs from CF to BTF resulted in improvement in GI symptoms, reduced need for GI medications, supported growth goals, and contributed to improved oral feeding.

Fluoride Determination in Milk, Soy, and Water-Based Products Using Ion-Selective Electrode and Direct Measurement Technique: Single-Laboratory Validation, First Action 2022.05.

BACKGROUND: The AOAC Stakeholder Panel on Infant Formula and Adult Nutritionals issued a call for methods for the determination of fluoride in infant formula. Standard Method Performance Requirement (SMPR®) 2014.016 was approved. OBJECTIVE: A single-laboratory validation (SLV) of a fluoride ion-selective electrode (F-ISE) method was completed. METHODS: Five powder samples were reconstituted, and hydrochloric acid was added to dissolve and release any bound fluoride. Samples included infant and adult nutritional products made from milk, whey, or soy, containing intact, partially hydrolyzed, or hydrolyzed proteins. Sodium citrate buffer was added to complex any interfering ions and adjust pH and ionic strength. Samples were analyzed in duplicate over 6 days using F-ISE. RESULTS: Results were calculated based on one of two least-squares (log fit) standard curves (0.02 to 0.1 µg/100 g or 0.1 to 2.0 µg/100 g). The LOQ for the method was determined to be 3.3 µg/100 g, which was far below the minimum analytical value of 30 µg/100 g required in the SMPR. The fluoride concentrations ranged from approximately 3 to 14 µg/100 g reconstituted powder and the intermediate precision, RSDr, ranged from 0.7 to 12.4%. Although all of these results are out of scope for the SMPR due to their low fluoride, it should be noted that the RSDr for formulas with fluoride concentrations ranging from approximately 9 to 14 µg/100 g ranged from 0.7 to 4.3%, and the RSDr for the two formulas with fluoride concentrations at or below the theoretical detection limit of the method were only approximately10 and 12.4%. Recoveries ranged from 94 to 98% for samples spiked at three levels with NIST-traceable standard solutions, meeting the SMPR. CONCLUSION: The F-ISE method meets the SMPR and was adopted as a First Action Official MethodSM. HIGHLIGHTS: The fluoride ion-selective electrode method presented here is affordable and easy to run. The addition of acid to the samples dissolves any minerals which may bind the fluoride.

Evaluation of Mothers’ Sociodemographic Characteristics and Infant Feeding Attitudes During Pregnancy According to the Iowa Feeding Attitude Scale and Examining the Scale’s Role in Determining Breastfeeding Duration / Evaluación de las características sociodemográficas de las madres y las actitudes hacia la alimentación infantile durante el embarazo según la escala de actitud hacia la alimentación de Iowa y examen del papel de la escala en la determinación de la duración de la lactancia materna

Introduction: The World Health Organization recommends exclusive breastfeeding for the initial 6 months of life, followed by the introduction of supplementary foods together with breast milk after 6 months, and then continuing to breastfeed until the child reaches 2 years of age. Iowa Infant Feeding Attitude Scale (IIFAS) was developed to identify which infant feeding methods pregnant women are more inclined towards during the early stages of pregnancy. In our study, we aimed to assess the feeding practices of mothers using the IIFAS. Material and methods: The study was planned with consenting pregnant women who applied to the gynaecology clinic, pregnancy outpatient clinic and pediatric outpatient clinic of our hospital. Those who had problems such as drug use, chronic disease, psychological disorder, anatomical disorder that would prevent breastfeeding, syndromic condition, indication for hospitalisation were excluded from the study. A questionnaire regarding the demographic profile of the mothers and the IIFAS was filled out. Subsequently, face-to-face interviews were conducted with the mothers on the seventh day, third month, and sixth month to gather information. Results: The study was completed with 96 mothers. According to the IOWA infant feeding scale scores of the mothers, there were 26 (27.1%) mothers in the breastfeeding-prone group with a score of 70 and above and 70 (72.9%) mothers in the undecided group with a score between 49-69. Since none of the pregnant women scored between 17-48, the group predisposed to formula feeding was not formed. There were no significant variations observed between the groups with regard to age, family type, and mode of delivery; however, there was a notable disparity in the educational and informational statuses of the mothers. Conclusions: The fact that mothers were mostly undecided about the recommendations related to the IIFAS indicates the need for information about breast milk. (AU)

Introducción: La Organización Mundial de la Salud recomienda la lactancia materna exclusiva durante los 6 meses iniciales de vida, seguida de la introducción de alimentos suplementarios junto con la leche materna a partir de los 6 meses, y luego continuar con la lactancia materna hasta que el niño cumpla los 2 años de edad. La Escala de actitud hacia la alimentación infantil de Iowa (IIFAS) se desarrolló para identificar a qué métodos de alimentación infantil se inclinan más las mujeres embarazadas durante las primeras etapas del embarazo. En nuestro estudio, nuestro objetivo fue evaluar las prácticas de alimentación de las madres utilizando el IIFAS. Material y métodos: El estudio se planificó con el consentimiento de mujeres embarazadas que postularon a la consulta de ginecología, consulta externa de embarazo y consulta externa pediátrica de nuestro hospital. Fueron excluidos del estudio aquellos que presentaban problemas como consumo de drogas, enfermedad crónica, trastorno psicológico, trastorno anatómico que impediría la lactancia materna, condición sindrómica, indicación de hospitalización. Se llenó un cuestionario sobre el perfil demográfico de las madres y el IIFAS. Posteriormente, se realizaron entrevistas cara a cara con las madres los días séptimo día, tercer mes y sexto mes para recolectar información. Resultados: El estudio se completó con 96 madres. Según las puntuaciones de las madres en la escala de alimentación infantil de IOWA, había 26 (27,1%) madres en el grupo propenso a amamantar con una puntuación de 70 o más y 70 (72,9%) madres en el grupo indeciso con una puntuación entre 49- 69. Dado que ninguna de las mujeres embarazadas obtuvo una puntuación entre 17 y 48, no se formó el grupo predispuesto a la alimentación con fórmula. No se observaron variaciones significativas entre los grupos con respecto a la edad, tipo de familia y modo de parto; sin embargo, ... (AU)

Standards for the Use of Enteral Nutrition in Patients with Diabetes or Stress Hyperglycaemia: Expert Consensus.

(1) Background: Hyperglycaemia that occurs during enteral nutrition (EN) should be prevented and treated appropriately since it can have important consequences for morbidity and mortality. However, there are few quality studies in the literature regarding the management of EN in this situation. The objective of this project was to attempt to respond, through a panel of experts, to those clinical problems regarding EN in patients with diabetes or stress hyperglycaemia (hereinafter referred to only as hyperglycaemia) for which we do not have conclusive scientific evidence; (2) Methods: The RAND/UCLA Appropriateness Method, a modified Delphi panel method, was applied. A panel of experts made up of 10 clinical nutrition specialists was formed, and they scored on the appropriateness of EN in hyperglycaemia, doing so in two rounds. A total of 2992 clinical scenarios were examined, which were stratified into five chapters: type of formula used, method of administration, infusion site, treatment of diabetes, and gastrointestinal complications. (3) Results: consensus was detected in 36.4% of the clinical scenarios presented, of which 23.7% were deemed appropriate scenarios, while 12.7% were deemed inappropriate. The remaining 63.6% of the scenarios were classified as uncertain; (4) Conclusions: The recommendations extracted will be useful for improving the clinical management of these patients. However, there are still many uncertain scenarios reflecting that the criteria for the management of EN in hyperglycaemia are not completely standardised. More studies are required to provide quality recommendations in this area.

Small peptide formulas versus standard polymeric formulas in critically ill patients with acute gastrointestinal injury: a systematic review and meta-analysis.

Small peptide formulas versus standard polymeric formulas for enteral nutrition in critically ill patients with acute gastrointestinal injury (AGI) have been a topic of debate. A systematic review and meta-analysis were conducted to compare their clinical and nutritional outcomes. Relevant studies from January 1980 to June 2022 were searched in PubMed, Cochrane, and Embase databases. Randomized controlled trials involving AGI grade I-IV patients were included, while children, non-AGI patients, and non-critically ill patients were excluded. Results indicated no significant difference in all-cause mortality. Patients receiving small peptide formulas showed higher daily protein intake, greater albumin growth, and higher prealbumin levels. They also had shorter lengths of stay in the intensive care unit and hospital. Conversely, patients receiving standard polymeric formulas had a higher daily calorie intake. In conclusion, the choice of formula may not affect mortality in critically ill patients with AGI. Small peptide formulas were more conducive to increase daily protein intake, decrease intensive care unit and hospital length of stay. Further large-scale randomized controlled trials evaluating the effects of these two nutritional formulas on clinical and nutritional outcomes in critically ill patients with AGI are needed to confirm these results.

Older Infant-Young Child "Formulas".

The category of "formulas" directed at older infants and toddlers 6 to 36 months of age has increased in prominence over the last years but is characterized by lack of standardization in nomenclature and composition as well as questionable marketing practices. There has been uncertainty and misperception regarding some of the roles of these beverages in ensuring adequate childhood nutrition. The aim of this clinical report is to review the context, evidence, and rationale for older infant-young child formulas, followed by recommendations.

Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition.

Prior to the 1970s, blending food and liquids and putting them through an enteral access device (EAD) was the most common form of enteral nutrition (EN). However, in the 1970s, blenderized tube feedings (BTFs) became less popular due to the emergence of modern commercial enteral formulas (CEFs). Recently, a cultural shift toward consuming a natural diet, consisting of whole foods, has led to a resurgence in the use of BTF. The increasing use of BTF in a variety of patient care settings identifies a need for practice recommendations that provide guidance for nutrition professionals and patients. Members of the American Society for Parental and Enteral Nutrition (ASPEN) Enteral Nutrition Committee identified salient clinical questions concerning BTF, conducted a comprehensive literature search, and subsequently developed practice recommendations pertaining to the use of BTF. This paper was approved by the ASPEN 2022-2023 Board of Directors.

Experience with the management of patients requiring home enteral nutrition in routine clinical practice in Spain: the ECONES study / Experiencia en el manejo de pacientes que requieren nutrición enteral domiciliaria en la práctica clínica habitual en España: el estudio ECONES

Introduction: enteral nutrition is an effective method for restoring the nutritional status in patients unable to eat or fulfil nutritional requirements orally. Objectives: the ECONES study aimed to describe the treatment of patients requiring home enteral nutrition (HEN) in routine practice and the experience of specialists with the high-protein hypercaloric formula 2.0 with fiber IS50 (HP/HC 2.0). Methods: Spanish specialists answered a 38-questions survey about their last six patients with HEN and their treatment with HP/HC 2.0 formula. Results: the formulas were chosen based on the patients’ requirements. HP/HC 2.0 was administered in a mean of 31.5 % of patients, and for a mean of 42.2 % of those, it was selected since the beginning of treatment. According to 92.4 % of specialists, the HP/HC 2.0 was considered as adequate based on nutritional requirements. Among adverse reactions, specialists reported diarrhea, bloating and constipation. Specialists reported that caregivers (90.6 %) stated that HP/HC 2.0 was well tolerated by patients (90.6 %) and expressed comfort with the frequency (75.3 %) and administration time (82.9 %).Conclusions: according to the specialists, formulas are chosen based on patients’ characteristics. Patients with high nutritional needs benefit from the HP/HC 2.0 formula as it allows volume restriction, presents few adverse events, and improves the quality of life of the patients. (AU)

Introducción: la nutrición enteral es un método eficaz para restaurar el estado nutricional en pacientes que no pueden comer o satisfacer los requerimientos nutricionales por vía oral.Objetivos: el estudio ECONES tuvo como objetivo describir el tratamiento de pacientes que requieren nutrición enteral domiciliaria (NED) en la práctica habitual y la experiencia de especialistas con la fórmula hipercalórica hiperproteica 2.0 con fibra IS50 (HP/HC 2.0).Métodos: los especialistas españoles respondieron a un cuestionario de 38 preguntas sobre sus últimos seis pacientes con NED y su tratamiento con fórmula HP/HC 2.0.Resultados: las fórmulas fueron elegidas en función de los requerimientos de los pacientes. Se administró HP/HC 2.0 en una media del 31,5 % de los pacientes, y se seleccionó desde el inicio del tratamiento para una media del 42,2 %. Según el 92,4 % de los especialistas, se consideró la HP/HC 2.0 adecuada en función de las necesidades nutricionales. Entre los acontecimientos adversos, destacaron la diarrea, hinchazón y estreñimiento. Los especialistas indicaron que los cuidadores (90,6 %) afirmaron que la HP/HC 2.0 fue bien tolerada por los pacientes (90,6 %) y expresaron comodidad con la frecuencia (75,3 %) y con el tiempo de administración (82,9 %).Conclusiones: según los especialistas, las fórmulas se eligen en función de las características de los pacientes. Los pacientes con altas necesidades nutricionales se benefician de la fórmula HP/HC 2.0, ya que permite la restricción de volumen, presenta pocos acontecimientos adversos y mejora la calidad de vida de los pacientes. (AU)

NEmecum: herramienta digital de ayuda a la prescripción y dispensación de fórmulas de nutrición enteral y preparados infantiles / NEmecum: digital tool for assisting in the prescription and dispensing of enteral nutrition formulas and infant preparations

Introducción: existe una amplia variedad de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles. La consulta de información relacionada debe hacerse en las herramientas propias de cada laboratorio, lo que dificulta la visión crítica y la comparativa entre las mismas. Objetivo: describir el desarrollo de NEmecum como la primera web que permite realizar una búsqueda dirigida e independiente de fórmulas de nutrición o preparados infantiles, analizar el abanico nutricional actual en España y evaluar los datos de uso de la herramienta. Métodos: se desarrolló la estructura de una base de datos que unifica los parámetros de todas las fórmulas y se analizó el abanico nutricional español. Posteriormente, se seleccionaron los principales algoritmos de búsqueda dirigida y se codificó la herramienta digital. Se llevó a cabo una intensa difusión y se evaluó el impacto obtenido. Se analizaron el perfil de usuarios y centros registrados y los datos de uso de la herramienta y se evaluó su usabilidad mediante el cuestionario System Usability Scale (SUS). Resultados: se obtuvo una web responsive de acceso gratuito (http://nemecum.com) que permite realizar búsquedas dirigidas en base a unos filtros de búsqueda preestablecidos. La herramienta permitió analizar detalladamente el abanico nutricional en España, observándose la gran variedad de fórmulas disponibles de similares características. La campaña de difusión consiguió incrementar su uso de forma exponencial y cuenta actualmente con 1.370 usuarios y 79 centros registrados. La usabilidad fue valorada como excelente. Conclusión: el desarrollo de NEmecum supone una herramienta valiosa en la búsqueda y consulta de datos de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles. (AU)

Introduction: there is a wide variety of enteral nutrition and infant formulas preparations. When there is a need to find infomation on a product,only the infomation from industy is available. Comparison amomg products becomes then ardous.Objective: to describe the development of NEmecum as the first website that allows a directed and independent search for enteral nutritionproducts and infant formulas, currently available in Spain, and to evaluate the initial use of NEmecum.Methods: the structure of a database that unifies the parameters of all formulas was developed, and the nutritional composition of all formulaswas analyzed. Subsequently, the main search algorithms were selected and the digital tool was codified. Intensive dissemination was performedand the impact was evaluated. The profile of users and registered centers and the use of the tool were analyzed, and its usability was evaluatedusing the System Usability Scale (SUS) questionnaire.Results: a free-access responsive website (http://nemecum.com) that allows searches based on pre-established search filters was obtained. Thistool allows for a detailed analysis available formulas in Spain by observing a wide variety of formulas with similar characteristics. The disseminationcampaign managed to increase its use exponentially, currently reaching 1,370 users and 79 registered centers. Usability was rated as excellent.Conclusion: the development of the NEmecum represents a valuable tool in the search and consultation of the characteristics of enteral nutritionformulas and infant preparations. (AU)