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Table 1 Summary of Eligible Studies

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

  1. Key: N Number of participants, FU Follow up, TF Time Frame, NG Nasogastric (Feeding), LOS Length of Stay, ED Eating disorder, EO Early onset, AN Anorexia nervosa, RS Refeeding syndrome, %IBW Percentage ideal bodyweight, HP Hypophosphataemia, OR Oral refeeding, RCT Randomised control trial