From: A systematic review of enteral feeding by nasogastric tube in young people with eating disorders
References | Study Design | Country Set | Time Frame / Follow up years (months) | N total (Female) | Age Range (years) | Setting | Aims | NG Primary/ Secondary Outcome? (Reason for Implementing NG) | Main Outcomes | Risk of Bias |
---|---|---|---|---|---|---|---|---|---|---|
Whitelaw et al., 2010 [9] | Cohort Study (retrospective) | Australia | TF 1 | 29 (not stated) | 12–18 | Adolescent Medical Ward | Assess whether more aggressive refeeding leaves patients at greater risk of HP | Secondary (Inadequate oral intake) | HP associated with lower %IBW and lower number of hospital admissions; 15% required NG feeding | Medium |
Rocks et al., 2014 [10] | Cross-Sectional Study (prospective) | Australia | TF 0 (3) | 17 (n/a) | N/A | Variety of Settings | Describe practices of Australian dietitians in management of AN | Secondary (Inadequate oral intake) | All dietitians stated OR was offered first with supplementation. 82% recommended implementing NG feeding as part of re-feeding process. | Medium |
Maginot et al., 2017 [18] | Cohort Study (retrospective) | USA | TF 1 | 87 (73) | 8–20 | Medical Behavioural Unit | Safety of higher calorie nutritional rehabilitation protocol (NRP) | Secondary (Inadequate oral intake) | Lower %IBW on admission more important predictor of HP than initial calories. Malnourished patients started on lower calories more likely to have NG tube. | Medium |
Paccagnella et al., 2006 [20] | Cohort Study (prospective) | Italy | TF 1 | 24 (24) | 11–32 | “Hospital” | Define minimal criteria for “lifesaving” treatment and submit a patient to NG | Secondary (medical instability) | Symptomatology improved the day after NG; is beneficial especially when used for life saving treatment initially | Medium |
Silber et al., 2004 [21] | Cohort Study (retrospective) | USA | TF 10 | 14 (0) | 12–18 | Adolescent Inpatient Unit | Determine outcomes of supplementing oral refeeding with nocturnal NG supplementation | Primary (Routinely) | Maximum kcals were greater, weight achieved at discharge greater in treatment group compared to oral refeeding only | High |
Madden et al., 2015 [22] | RCT (prospective) | Australia/ USA | TF 3 | 82 (78) | 12–18 | Paediatric Medical Ward | Long term outcomes of treating to restore weight rather than just to medically stabilise | Secondary (Medical instability) | No difference in hospital days used after initial admission, total fewer days in hospital to achieve medical stability. | Low |
Agostino et al., 2013 [23] | Cohort Study (retrospective) | Canada | TF 8 FU 0 (6) | 165 (158) | 10–18 | Paediatric Medical Ward | Difference in LOS between adolescent ED treated with short-term continuous NG feeding vs. managed with lower calorie meals | Primary (Routinely) | LOS reduced in the NG-fed cohort; No significant difference in complications or electrolyte abnormalities (90% NG cohort received prophylactic phosphate). | Medium |
Parker et al., 2016 [24] | Cohort Study (retrospective) | Australia | TF 3 | 167 (152) | 14–19 | Adolescent ED unit | Weight gain and complications associated with refeeding prescribed greater initial calories | Secondary (Medical instability) | Mean starting intake was 2611.7 kcal/day (58.4 kcal/kg) With inclusion of phosphate supplementation no increased risk of RS. | Medium |
Madden et al., 2015 [25] | RCT (prospective) | Australia | TF 1 (9) | 78 (74) | 12–18 | Paediatric ED service | More rapid refeeding protocol promotes initial weight recovery and medical stability. | Primary (Medical instability) | Adequate weight gain and minimal adverse effects were observed. All patients gained weight in week 1 with no cases of HP or RS. | Low |
Kezelman et al., 2018 [26] | Cohort (prospective) | Australia | TF 1 (2) FU 8–66 days | 31 (31) | 15–19 | Specialist ED Adolescent medical ward | Explore the relationship between anxiety and weight restoration | Secondary (Medical instability) | All patients received NG initially. No established relationship between changes in anxiety and weight restoration. | Medium |
Fuller et al., 2019 [27] | Cross-Sectional Study (prospective) | UK/ Ireland | TF 1 | 134 (n/a) | n/a | Variety of Settings | Identify common current practice and if specialist ED units are managing AN differently to other inpatient settings | Primary (Inadequate oral intake) | 43.3% reported that they were able to facilitate NG feeding; 79% of units providing NG feeding were able to facilitate physical interventions | Medium |
Street et al. 2016 [28] | Case Reports (prospective) | England | TF 3 FU 1–2 | 31 (30) | 10–17 | Paediatric medical ward | Evaluate joint care ED pathway between CAMHS and paediatric wards | Secondary (Medical Instability) | Time-limited admissions with boundaried-care plans are easier to manage and enjoyed feeling supported by CAMHS | High |
Couturier and Mahmood, 2009 [29] | Cohort Study (retrospective) | Canada | TF 2 FU 1 | 21 (19) | 11–17 | Psychiatric Inpatient Unit | Understand whether implementing meal support therapy reduced need for NG | Primary(Inadequate oral intake) | Meal support therapy reduces need for NG (66.7 to 11.1% after implementation (P < 0.02)) | Medium |
Falcoski et al.,2020 [30] | Case Series (prospective) | UK | TF 1 | 3 (2) | 11–14 | Specialist ED unit | Evaluate new dietetic guidelines for AN in clinical practice | Primary (variable) | Different use of NG feeding to suit individual; use of continuous and single bolus feeds via NG tube | High |
O’Connor et al., 2016 [31] | RCT (prospective) | UK | TF 2 | 36 (34) | 10–16 | Paediatric medical Ward | Higher calorie refeeding anthropometric outcomes, cardiac and biochemical markers | Secondary (Inadequate oral intake) | Adolescents on high energy intake had greater weight gain. 11% participants required NG feeding for failure to meet 80% oral intake. | Low |
Akgul et al., 2016 [35] | Case Series (retrospective) | Turkey | TF 4 | 13 (0) | 11–17 | Paediatric Medical Ward | Describe medical, psychiatric, cultural features of adolescent males with an ED | Secondary (Inadequate oral intake) | Male:female increased (3.6:1 F:M); 2/13 given NG due to refusal to eat in hospital | High |
Akgul et al., 2016 [36] | Cohort Study (retrospective) | Turkey | TF 6 | 35 (28) | 11–17 | Paediatric Medical Ward | Explore paediatric unit where no specific ED unit for to discuss refeeding approaches and goals for discharge | Primary (variable) | Paediatric ward is acceptable where specialist ED inpatient unit not viable; specialist unit better however limited resources | Medium |
Nehring et al., 2014 [37] | Cohort Study (retrospective) | Germany | TF 10 FU 1–12 | 208 (208) | 12–18 | Psychiatric Inpatient Unit | Short-term and long-term outcomes of treating with EN compared to no EN | Primary (not discussed) | No significant difference in recovery following NG; 34% had NG | Medium |
Neiderman et al., 2004 [38] | Case reports (prospective) | England | FU 1 | 4 (3) | 13–16 | Adolescent Unit | Report of gastrostomy or jejunostomy use in 4 cases of AN | Secondary (Medical instability) | 4/4 patients required NG feeding and progressed to require gastrostomy/jejuonostomy due to complications | High |
Robb et al., 2002 [39] | Cohort Study (retrospective) | USA | TF 6 | 100 (100) | 12–18 | Paediatric Medical Ward | Compare short-term outcomes of oral vs. supplemental nocturnal nasogastric refeeding | Primary (Routinely) | Weight gain significantly increased in treatment group, no significant difference in length of hospital stay | Medium |
Neiderman et al., 2001 [40] | Cross-Sectional Study (retrospective) | UK | TF 1–18 | 58 (21 patients 37 parents) (19/21) | Patients 9–17 at start of study | Paediatric Medical Ward | Analyse patient and parent views on NG feeding | Primary (not discussed) | 71% patients said they did not consent to NG feeding; patients feared weight gain and loss of control over calorie intake | High |
Gusella et al., 2017 [41] | Cohort Study (retrospective) | Canada | TF 13 FU 1 | 46 (43) | 9–15 | Outpatient ED team | Compare parent led treatment (PIC) to conventional treatment | Secondary (Medical Instability) | PIC had greater increase in %IBW, fewer hospitalisations, shorter admissions, less likely to receive NG feeding | Medium |
Madden et al., 2009 [42] | Cross-Sectional Study (prospective) | Australia | TF 3 | 101 (74) | 5–13 | Medical Ward and Psychiatric Inpatient Wards | Collect epidemiological data on EO-ED | Secondary (not discussed) | Most were hospitalised (78%), mean duration of hospitalisation was 24.7 days; 58% inpatients NG tube fed. | Medium |
van Noort et al., 2018 [43] | Cohort Study (prospective) | Germany | TF 3 | 120 (120) | 9–19 | Specialist ED unit | Evaluate characteristics of EO-AN compared with AO-AN. | Secondary (Inadequate oral intake) | NG tube feeding required more in EO-AN than AO-AN; Restrictive more common in EO. | Medium |
Strik Lievers et al., 2009 [44] | Cohort Study (prospective) | France | TF 8 | 213 (213) | 12–22 | Psychiatric Ward | Clinical variables influencing the length of stay (LOS) of inpatient treatment for AN | Secondary (Medical instability) | Requirement for tube feeding was predictor for LOS (longer) tube feeding required in 27% admissions. | Medium |
Halse et al., 2005 [45] | Cross-Sectional Study (prospective) | Australia | TF 1 | 23 (23) | 12–20 | Adolescent Medical Ward | Examine the meanings that patients attached to NG | Primary (N/A) | Categories: unpleasant physical experience, a necessary intervention, a physical and psychological signifier of AN, a focus in a struggle for control. | Medium |
Clausen et al., 2018 [46] | Cross-Sectional Study (retrospective) | Denmark | TF 13 | 4727 (4387) | 10–40+ | Psychiatric/ Medical Ward | Frequency of various involuntary measures in AN patients | Secondary (not discussed) | Involuntary tube feeding was most frequent measure used. | Low |
Bayes and Madden, 2011 [47] | Case Series (retrospective) | Australia | TF 2 | 10 (0) | 10–13 | Paediatric medical Hospital | Demographic and clinical features of male inpatients with EO ED | Secondary (Medical instability) | Only 3/10 participants met full criteria for AN; 60% required NG feeding. | High |
Kodua et al.,2020 [48] | Case Reports (prospective) | UK | TF 1 | 8 (n/a) | n/a | ED inpatient units | Nursing assistants’ experiences of manual restraint for NG feeding | Primary (N/A) | 3 primary themes were gathered: an unpleasant practice, importance of coping, becoming (de)sensitized to NG feeding. | High |