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Intestinal perforations by tube feedings in small infants: clinical and experimental studies
Insights
Transpyloric tube feedings in low-birth-weight neonates may increase the risk of duodenal or jejunal perforations. Experimental rabbit studies suggest tube feedings contribute to mucosal damage, potentially leading to bowel perforation.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Surgical Pathology
Background:
- Transpyloric tube feeding is common in low-birth-weight neonates.
- Bowel perforation is a serious complication in this population.
- The specific role of transpyloric feeding in neonatal bowel perforation requires further elucidation.
Purpose of the Study:
- To report clinical and radiographic findings of neonatal duodenal/jejunal perforations linked to transpyloric feeding.
- To investigate the potential causal relationship between transpyloric tube feeding and bowel perforation in an experimental model.
Main Methods:
- Retrospective review of eight low-birth-weight neonates with duodenal/jejunal perforations associated with transpyloric feeding.
- Experimental study in young rabbits using Silastic or polyvinyl chloride tubes placed in the duodenum/jejunum.
- Comparison of outcomes between rabbits receiving tube feedings versus normal oral feedings.
Main Results:
- Four neonate perforations occurred distal to the known tube tip.
- Rabbits with tube feedings showed higher rates of perforation and mucosal abnormalities compared to controls.
- Mucosal damage was observed in the vicinity of and beyond the feeding tubes.
Conclusions:
- Transpyloric tube feedings may induce mucosal damage.
- This mucosal damage appears to be a contributing factor to bowel perforation in neonates.
- Further research is warranted to confirm the mechanism and optimize feeding protocols.
Abstract:
The clinical and radiographic findings of eight low-birth-weight neonates (mean, 900 g) with perforations of the duodenum or jejunum associated with transpyloric feedings are reported. In four patients, the perforations occurred distal to any known tube position. In experimental studies in young rabbits, Silastic or polyvinyl chloride tubes were sewn in place with the tube tips in the proximal duodenum or proximal jejunum, and either normal oral feedings or feedings through the tubes were given. Perforations and gross or microscopic abnormalities of the bowel mucosa in the area of the tubes and beyond were more frequent in rabbits with tube feedings than those given normal oral feedings. It appears that tube feedings induce some degree of mucosal damage and contribute to bowel perforation.