Effect of abdominal massage on feeding intolerance in patients receiving enteral nutrition: A systematic review and meta‐analysis

Combining orofacial stimulation with gentle touch therapy improves breastfeeding tolerance and weight gain in preterm infants

OBJECTIVE

To investigate the effect of orofacial stimulation combined with gentle touch therapy on breastfeeding intolerance and weight gain in preterm infants.

METHODS

This retrospective cohort study was conducted at Wuhan Children's Hospital, involving 236 preterm infants diagnosed with breastfeeding intolerance. Of these, 130 infants received a combination of gentle touch and orofacial stimulation (combination group), while 106 infants received only gentle touch therapy (only-touch group). The intervention lasted for three months. Outcomes were assessed using clinical indicators of breastfeeding intolerance, the Neonatal Oral Motor Assessment Scale (NOMAS), growth measurements (weight, height, and head circumference), and levels of calcium, albumin, prealbumin, and bilirubin. Statistical analyses were performed using SPSS 23.0.

RESULTS

The combination group demonstrated a higher rate of improvement in breastfeeding intolerance compared to the only-touch group (significantly improved cases: 60 vs. 30; ineffective cases: 7 vs. 44; χ2 = 28.267, P < 0.05). Oral motor function improved significantly more in the combination group (P < 0.05). After 1 and 3 months, the combination group showed greater increases in weight, height, and head circumference (Height: P = 0.025 at 1 month; Head circumference: P = 0.034 at 3 months). The duration of residual milk was significantly reduced in the combination group by the end of the observation period (P < 0.001). Nutrient analysis revealed higher levels of calcium, albumin, and prealbumin post-nursing (P < 0.05), and bilirubin levels decreased significantly after one month (t = 5.987, P < 0.05).

CONCLUSION

Combining orofacial stimulation with gentle touch therapy improves breastfeeding tolerance, oral motor function, growth, and nutritional status in preterm infants more effectively than touch therapy alone.

Knowledge, attitude, and practice of nurses regarding enteral feeding: a systematic review

BACKGROUND

Enteral feeding uses feeding tubes for liquid food administration. Enteral feeding maintains gastrointestinal function but has complications like aspiration, diarrhea, and constipation. To avoid complications, nurses in intensive care units must have proper knowledge, attitude, and practice towards enteral feeding.

METHOD

A systematic review was conducted. The search was restricted to January 2000 to April 2024, encompassing scientific journals accessible via the following online databases: PubMed (including Medline), Cochrane Library, Scopus, Web of Science, and Embase. Google Scholar was searched comprehensively to include all relevant studies. The search strategy employed the following keywords and medical subject headings: [knowledge OR attitude] AND [enteral feeding OR enteral nutrition] AND nurs*. Only cross-sectional studies were included in this systematic review. Two authors independently conducted the selection of eligible studies, data extraction, and risk of bias assessment. Due to the discrepancies in methodologies and research goals among the investigated studies, a narrative synthesis was conducted.

RESULTS

In total, there were 3187 articles found in the initial search across five online electronic databases. Finally, a thorough review was conducted, incorporating 22 studies. Based on the studies analyzed in this systematic review, nurses showed a positive attitude toward enteral feeding; there was a necessity to enhance their knowledge and practice. Continuous education combined with interdisciplinary collaboration can significantly improve nurses' knowledge and practice of enteral feeding.

CONCLUSION

Many studies highlight the necessity of enhancing the knowledge and practice of nurses in this area. Implementing educational interventions has positively impacted nurses' knowledge and performance.

Laparoscopic intracorporeal anastomosis vs open anastomosis for ileostomy reversal in Crohn's disease: A single center retrospective study

BACKGROUND

There is an increased maturation of laparoscopic intracorporeal anastomosis techniques. However, research on its application for small bowel stoma reversal in patients with Crohn's disease (CD) is limited. Therefore, in this study, we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal (LIIR) and open ileostomy reversal (OIR).

AIM

To compare the safety, feasibility, bowel function recovery, and short- and long-term LIIR and OIR outcomes in patients with CD.

METHODS

This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution. The baseline data, postoperative recovery, and complication indicators were retrospectively analyzed. Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.

RESULTS

Notably, 15 of the 45 patients in this study underwent OIR, and the remaining 30 received LIIR. Notably, no statistically significant differences were found between the two groups regarding clinical baseline characteristics, operation time, intraoperative hemorrhage, anastomotic site, enterolysis range, first postoperative flatus, postoperative complications, reoperation rate, or incidence of postoperative enteral nutrition intolerance. Compared with the OIR group, the LIIR group had a shorter postoperative hospital stay (P = 0.045), lower incidence of enteral nutrition intolerance symptoms (P = 0.019), and earlier postoperative total enteral nutrition initiation (P = 0.033); however, it incurred higher total hospital costs (P = 0.038). Furthermore, multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance (P < 0.05).

CONCLUSION

Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible. Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.

Effectiveness of non-pharmacological interventions to prevent enteral nutrition intolerance in ICU patients: A network meta-analysis

BACKGROUND

Enteral nutrition is beneficial for improving the clinical outcomes of intensive care unit patients. However, enteral nutrition intolerance is a common complication in intensive care unit patients undergoing enteral nutrition.

AIMS

We aimed to assess the effectiveness of non-pharmacological interventions in preventing enteral nutrition intolerance in intensive care unit patients and to identify the optimal non-pharmacological interventions.

STUDY DESIGN

Seven databases were searched to obtain randomized controlled trials involving non-pharmacological interventions to prevent enteral nutrition intolerance in intensive care unit patients. Network meta-analysis was performed using Stata18.0 software, and the integrated data were investigated with odds ratio (OR) and 95% confidence interval (95% CI).

RESULTS

A total of 16 randomized controlled trials involving 10 non-pharmacological interventions and 1765 intensive care unit patients were included. Compared with routine enteral nutrition care, network meta-analysis showed that bundled care [OR = 0.93, 95% CI (0.32-1.53)] (p = .003), intra-abdominal pressure monitoring [OR = 1.68, 95%CI (1.19-2.16)] (p < .001), acupuncture [OR = 2.69, 95%CI (1.64-3.73)] (p < .001), pectin-added intermittent enteral nutrition [OR = 1.13, 95%CI (0.48-1.77)] (p = .001), multidisciplinary nutritional treatment model [OR = 1.98, 95%CI (0.87-3.10)] (p < .001), abdominal massage [OR = 2.42, 95%CI (1.50-3.34)] (p < .001) and intermittent feeding with semisolid nutrients [OR = 2.08, 95%CI (0.19-3.97)] (p = .031) were effective in preventing enteral nutrition intolerance in intensive care unit patients. The ranking probabilities of the interventions indicated that acupuncture (89.4%) was the optimal non-pharmacological intervention for preventing enteral nutrition intolerance in intensive care unit patients, followed by abdominal massage (83.4%).

CONCLUSIONS

Acupuncture and abdominal massage are recommended to prevent enteral nutrition intolerance in intensive care unit patients. Moreover, more high-quality trials are needed to investigate the reliability of evidence levels for different non-pharmacological interventions.

RELEVANCE TO CLINICAL PRACTICE

This study provided evidence for intensive care nurses that acupuncture is the optimal intervention to improve enteral nutrition intolerance in intensive care unit patients among the 10 interventions. However, unique clinical circumstances should be considered. Therefore, we recommend that intensive care nurses also use abdominal massage when acupuncture is not available.

Abdominal massage for chronic constipation in the elderly: a systematic review and meta-analysis protocol

INTRODUCTION

Chronic constipation (CC) is a highly prevalent health challenge that is particularly challenging to treat in elderly patients. Although lifestyle guidance and laxative therapy often yield positive outcomes, patients occasionally struggle with maintaining dietary control. Therefore, identifying an economical and safe alternative therapy to the existing treatment methods documented in the international literature is necessary. This systematic review and meta-analysis aims to evaluate the efficacy and safety of abdominal massage in elderly patients with CC to provide a basis for future mechanistic research.

METHODS AND ANALYSIS

Electronic searches will be conducted to identify clinical randomised controlled trials in various databases, including Web of Science, PubMed, Cumulated Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Airiti Library, Chinese National Knowledge Infrastructure Databases, Chinese Science and Technology Periodical Database (VIP), Chinese Biomedical Literature Database and Wan Fang Database. Relevant data will be extracted, and a meta-analysis will be conducted using Reviewer Manager V.5.4. Quality and risk assessments of the included studies will be performed, and the outcome indicators of the trials will be observed. This review will evaluate abdominal massage as a treatment option for relieving symptoms and improving quality of life in elderly patients with CC. Moreover, it will provide additional insights for clinical treatment and mechanistic studies. The search will be performed following the publication of this protocol (estimated to occur on 30 December 2023).

ETHICS AND DISSEMINATION

As this is a literature review, ethics approval will not be required. We will disseminate the findings of this study to publications in peer-reviewed journals as well as presentations at relevant national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42023408629.