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Table 2 Nasogastric Feeding Protocol and Complications Identified in Studies Included in this Systematic Review

From: A systematic review of enteral feeding by nasogastric tube in young people with eating disorders

Study

Risk of Bias

Setting

Method and Reason for Implementation of NG

Feeding Regime

Complications

Whitelaw et al, 2010 [9]

Medium

Medical Ward

Oral intake supplemented with bolus NG feeding if oral RDI not met

Minimum of 1900kcals on day 1 and increased by 300 kcal per day

38% developed HP. HP was associated with lower %IBW on admission

Rocks et al, 2014 [10]

Medium

MH and Medical Wards

High energy supplements and NG feeds were commonly used to meet RDI.

The initial calorie intake recommended was between 800-1750kcals

Not discussed

Maginot et al, 2017 [18]

Medium

Medical Ward

Bolus NG feeds supplemental to oral intake if RDI not met

Average of 1185 kcal average which increased to an average of 1781 kcals (range 1500–3000 kcals)

Hypomagnaemia and HP reported, HP was more likely in those under 80% %IBW

Paccagnella et al, 2006 [20]

Medium

Unknown

Continuous NG feeding until medically stable

15.9–19.7 kcal/kg/day; increased to 30 kcal/kg/day after 24 h.

No patient developed nausea, vomiting, or worsened abdominal symptoms; 2 developed lower limb oedema despite slow infusion.

Silber et al, 2004 [21]

High

MH Ward

Routine nocturnal NG feeding to supplement daily oral intake vs oral refeeding only (control)

Nocturnal NG feeding regime patients were prescribed calories individually (max 4350 kcal) and 3400 in the oral refeeding group (control).

Epistaxis, nasal irritation.

Madden et al, 2015 [22]

Low

Medical Ward

Continuous NG feeding until medically stable; followed by oral intake with supplemental nocturnal NG feeding until biomarkers stabilised.

NG feeding continuously for 1–2 days. Weight gain aim for 1 kg per week. Weaning to oral diet occurred as soon as medically stable – average 14 days on NG with feed of 2400-3000 kcal per day

Not discussed

Agostino et al, 2013 [23]

Medium

Medical Ward

Routine continuous NG feeding at a higher calorie intake compared to lower calorie standard oral intake.

Starting range for NG cohort 1200-2000 kcal increased by 200 kcal/day vs. oral diet of 800-1200 kcal increased by 150 kcal/day. NG fed for 7 days then weaned over 3 days with kcal via NG reducing as meals replaced

Oral cohort 51% lost weight initially compared to 6% in the NG high kcal cohort. 2 cases of Hypokalaemia (although both were abusing laxatives), HP.

Parker et al, 2016 [24]

Medium

MH Ward

Continuous NG feeding or combination of oral intake with supplemental overnight NG feeding, or oral intake alone.

Start feed 2400 kcal increasing to 2400-3400 kcal/day at 100 ml per hour

Peripheral oedema (4%), hypomagnaemia (7%), hypokalaemia (2%), HP (1%). No incidence of RS or delirium.

Madden et al, 2015 [25]

Low

Medical Ward

Continuous NG feeding until medically stable; followed by oral intake with supplemental nocturnal NG feeding until biomarkers stabilised. Average %IBW at initiation was 78

2400-3000 kcal to meet weekly target of weight gain of 1 kg/week. In the first week average weight gain was 2.79 kg.

Stated none developed RS or HP

Kezelman et al 2018 [26]

Medium

Medical Ward

Continuous NG until medically stable followed by oral intake supplemented by nocturnal NG feeding

2400 kcal/day for 24 h or until medically stable, changed to oral diet starting ~ 1800 kcal increasing to a maximum of 3800 kcal with nocturnal NG top up feeds stopped when BMI > 18.5

Not discussed

Fuller et al, 2019 [27]

Medium

MH Ward

Results from questionnaire showed non-specialist psychiatric units gave 73% NG as syringe bolus, 27% as enteral pump. Specialist ED units gave 85% as syringe bolus, 15% as enteral pump.

Volume of bolus feed ranged from 330 to 1000 ml average 564 ml per feed. Bolus feed time ranged between 10 and 40 min average being 20 min. If delivered by pump it was > 1 h.

Not discussed

Street et al, 2016 [28]

High

Medical Ward

Bolus NG feeding if medically unstable and oral intake not met

NG feeds were higher in calories than meals to motivate eating.

Not discussed

Couturier and Mahmood, 2009 [29]

Medium

MH Ward

Bolus NG feeding if patient failed to gain 1 kg/week or acute refusal of meals

Not discussed

Nausea, odynophagia, self-harm, epistaxis, anxiety, sadness, 38.4% patients experienced mild HP

Falcoski et al, 2020 [30]

High

MH Ward

Oral calories supplemented with bolus NG feeds, single bolus of high calorie NG feeding, and 3 smaller single boluses.

Starting feed 1200 kcal, increased by 200 kcal per day to 2000 kcal. 1 NG feed per day under restraint. Also described 1 bolus feed of 2000 kcal due to no oral intake for 20 h

Distress described during the procedure requiring Lorazepam

O’Connor et al, 2016 [31]

Low

Medical Ward

Supplemental bolus NG feeding if patients failed to meet 80% RDI. At initiation %IBW was < 78%

Compared 500 kcal starting diet with 1200 kcal

HP (28%)

Akgul et al, 2016 [35]

High

MH Ward

Not discussed

Initiated at 750 kcal per day and increased by 220 kcal per day

HP described in 2 cases (unable to determine if this was in those requiring NG)

Akgul et al, 2016 [36]

Medium

Medical Ward

Not discussed, the majority of young people were under 80% %IBW

Started on an average of 975 kcal. Average duration of NG was 2.5 days

HP described in 2 cases (not stated if this was in those requiring NG)

Robb et al, 2002 [39]

Medium

Medical Ward

Nocturnal NG feeding to supplement daily oral intake during medical instability

Starting NG feed at 600 kcal. Ratio oral kcal to NG was approximately 2:1. NG feed via pump at 40 cc per hour for 4 h then 60 cc per hour for 4 h. Increases to 1200 kcal NG feed over 3 nights. Weaned when the young person is 95%IBW.

Epistaxis (11.5%), anxiety (3.8%) treated with Lorazepam, removal of NG tube (5.8%), nasal irritation (28.8%).

Neiderman et al, 2001 [40]

High

Medical Ward

Not discussed

Not discussed

Removal of tube (55%).

  1. Key: BMI Body Mass Index, NG Nasogastric, MH Mental health, RDI Recommended daily intake, HP Hypophosphataemia, RS Refeeding syndrome, %IBW Percentage ideal bodyweight