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Neonatal Feeding Tube Colonization and the Potential Effect on Infant Health: A Review
Leslie A Parker1, Marina Magalhães1, Katelyn Desorcy-Scherer1
1Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States.
Insights
Neonatal feeding tubes can harbor significant bacteria, posing health risks to vulnerable infants. Longer use increases bacterial load, highlighting the need for further research in neonatal intensive care units.
Area of Science:
- Neonatal intensive care
- Microbiology
- Pediatric nutrition
Background:
- Infants in neonatal intensive care units (NICU) often require prolonged feeding tube (FT) use.
- FTs in contact with milk/formula are prone to rapid bacterial growth.
- Immature infant systems increase health risks from FT colonization.
Purpose of the Study:
- To review and summarize evidence on bacterial colonization of neonatal FTs.
- To identify research gaps concerning FT bacterial colonization in infants.
Main Methods:
- Searched Medline, CINAHL, and Embase databases.
- Included clinical and laboratory-based studies (observational, randomized controlled).
- Focused on studies investigating bacteria in neonatal FTs.
Main Results:
- Neonatal FTs can harbor high quantities of pathogenic and antibiotic-resistant bacteria.
- Extended FT dwell times may correlate with increased bacterial load.
- FT colonization may originate nosocomially and negatively impact infant health.
Conclusions:
- FTs represent an overlooked source of bacterial colonization in NICU infants.
- Bacterial presence in FTs is critical for understanding infant morbidity.
- More robust clinical studies are needed for evidence-based recommendations.
Background:
Infants in the neonatal intensive care unit (NICU) often require feeding tubes (FT) for weeks to months. Because FTs are in near constant contact with human milk and/or formula, rapid and extensive bacterial growth is possible. Due to their immature immunologic and gastrointestinal (GI) systems, infants may be at significant health risk due to FT colonization. In adults, length of time FTs remain in place (dwell time) affects the degree of colonization and biofilm formation which is important in infants whose tubes remain in place up to 30 days.
Objective:
The purpose of this review was to describe and summarize the evidence regarding FT bacterial colonization in infants and identify gaps needing further investigation.
Methods:
Medline, CINAHL, and Embase databases were searched for clinical and/or laboratory-based observational and randomized controlled studies investigating the presence of bacteria in neonatal FTs.
Results:
This review of 10 studies found evidence that neonatal FTs may contain high quantities of potentially pathogenic and antibiotic resistant bacteria and longer dwell times may increase the bacterial load. Furthermore, evidence suggests FT colonization may be nosocomial in origin and contribute to adverse infant health. Feeding tubes are an unrecognized source of bacterial colonization which may increase morbidity in premature infants and thus the presence of bacteria in FTs is an important area of investigation in the nutritional care of vulnerable infants in the NICU.
Implications:
Further appropriately powered studies which are clinically based, use appropriate analyses, and control for potential covariates are necessary to make clinical recommendations.
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