Enteral Nutrition Newsletter May-June 2012

Amy Long Carrera, MS, RD, CNSC, CWCMS
Registered Dietitian Nutritionist
05/14/12  9:47 PM PST

Food Allergy Awareness Week 

May 13-19, 2012

Established in 1991, the Food Allergy and Anaphylaxis Network (FAAN) is a trusted source of information, programs and resources related to food allergy and anaphylaxis. FAAN serves as the communication link between patients and caregivers. Its 22,000 members include nurses, dietitians, physicians, families and school staff.

Approximately 15 million Americans suffer from food allergies.Six million of them are children. Strict avoidance of the allergy-causing food or nutrient is the only way to avoid a potentially life-threatening reaction. Hydrolyzed (predigested protein) and elemental (amino acid-based) formulas are specialized products indicated for infants and children who cannot tolerate intact protein.

P E D I A T R I C   C O R N E R

Food Protein-Induced Enterocolitis Syndrome (FPIES) is described as severe gastrointestinal infl ammation in the small and large intestines caused by allergic reaction to a food protein. Although the typical age of onset is under 9 months, there have also been reported cases of FPIES in older children. For infants less than 6 months, the reaction is most likely related to the intake of milk or soy protein from infant formula. The onset of symptoms occurs within 24 hours and may include:

• Abdominal distention • Diarrhea  • Bloody stools • Vomiting • Ileus (can quickly progress to sepsis and shock)

Once the diagnosis of FPIES is confirmed by a GI Specialist or Allergist, dietary management typically includes the transition to an amino acid-based formula and the avoidance of offending foods.

Featured Products From Shield HealthCare:

Neocate® Infant DHA & ARA, Neocate® Junior, Neocate® Nutra

Shield HealthCare has you covered when it comes to hypoallergenic products for infants and children with cow and soy milk allergy or food allergy-associated conditions, such as Short Bowel Syndrome or Eosinophilic Esophagitis.

• Neocate® Infant DHA & ARA is a nutritionally complete amino acid-based formula for infants 0-12 months old.

• Neocate® Junior is indicated for children aged 1-10 years.

• Neocate® Nutra is an amino acid-based semi-solid medical food for children over 6 months of age.

Contact your local Shield HealthCare Registered Dietitian for our complete offering of hypoallergenic and elemental formulas.

Healthy At Home

Gastric Residual Volumes: A.S.P.E.N. Practice Recommendations

Both the accuracy of GRV measurement and its relationship to aspiration are controversial.

Nevertheless, it is a common practice. A.S.P.E.N. reviewed the available evidence to come up with the following recommendations:

1. Evaluate all patients for aspiration risk. Supine positioning, presence of a nasogastric tube, vomiting and bolus feeding can put a patient at greater risk for aspiration.

2. Confirm tube placement before initiating feedings. The most effective way to do this is to check previously-placed tube graduation marks.

3. Keep HOB at 30-45 degrees during feedings and for 30-60 minutes afterward.

4. If the GRV is >/= 250 mL after a second check, consider a promotility agent in adults.

5. For GRV > 500 mL, hold the feeding and assess for intolerance symptoms, such as abdominal distention, nausea, vomiting and glycemic control.

6. Consider placing the feeding tube beyond the ligament of Treitz when GRVs are consistently > 500 mL.

Shield HealthCare Registered Dietitians Take Excellent Care of Your Patients

CL is a 60 year-old male with esophageal cancer. After undergoing an esophagectomy,he had a J-tube placed. His wife was very anxious about administering his enteral feeding. CL was concerned about a decreased quality of life on tube feeding. Lisa, our Walnut Creek RD, spent over an hour with the patient’s wife, reviewing tube flushing to prevent clogging, programming the ambulatory feeding pump, practicing safe feeding precautions and recognizing signs of intolerance. To CL’s delight, Lisa showed him and his wife how to advance the feeds to allow for time off the pump at home and how to use the enteral backpack while out and about. Upon completion of the training with Lisa, CL’s wife was able to train other family members on the operation of the pump. She felt more comfortable taking her husband home knowing that she had the support of her Home Health Agency and her Shield HealthCare RD to assist with questions and concerns.


Food Allergy and Anaphylaxis Network   foodallergy.org

Kids with Food Allergies Foundation  kidswithfoodallergies.org

A.S.P.E.N. Enteral nutrition practice recommendations. JPEN, March 2009

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