An open-label clinical study to evaluate the safety and gastrointestinal tolerance (product compliance) of Groviva®® Advance in hospitalized children requiring isocaloric formula for enteral tube feeding

Main Article Content

Parag Dekate Avinash Reddy Kalyan Kunchapudi

Abstract

Objective: The aim of this study is to evaluate the safety and gastrointestinal tolerance of Groviva® Advance in pediatric patients hospitalized to pediatric intensive care units (PICUs) and requiring an isocaloric formula for enteral tube feeding.


Design: This was a prospective five-day single centre, open label clinical study.


Methods: The safety and tolerance of Groviva® Advance (45 gram in 170 millilitres of water) was evaluated every day from Day 1 to the end of hospitalization or Day 5, whichever was earlier. The reconstituted amount was 210 millilitres (equivalent to 200 kcal [1kcal in 1ml]) and dosed three hourly (or at the discretion of the pediatrician).


Results: The majority of participants received the Groviva® Advance tube feed three hourly on all five days of the study. The average range of total feeds varied from 295.16 ± 275.19 to 1074.737 ± 347.94 feeds per day. The most common side effects were loose stools or vomiting; if present, majority of participants had only one episode per day. There was minimal or no total daily aspiration or GRV (>500 ml/day). There was no statistically significant change in weight (P=0.7163) and abdominal girth (0.6381) of study participants. There were no issues encountered during the preparation and administration of Groviva® Advance.


Conclusion: Groviva® Advance was found to be safe and well tolerated by critically ill children admitted to PICUs.

Keywords: Groviva® Advance, enteral tube feed, isocaloric formula, pediatric, critically ill, intensive care unit

Article Details

How to Cite
DEKATE, Parag; REDDY, Avinash; KUNCHAPUDI, Kalyan. An open-label clinical study to evaluate the safety and gastrointestinal tolerance (product compliance) of Groviva®® Advance in hospitalized children requiring isocaloric formula for enteral tube feeding. Medical Research Archives, [S.l.], v. 12, n. 7, july 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5419>. Date accessed: 05 aug. 2024. doi: https://doi.org/10.18103/mra.v12i7.5419.
Section
Research Articles

References

1. Brown AM, Carpenter D, Keller G, Morgan S, Irving SY. Enteral Nutrition in the PICU: Current Status and Ongoing Challenges. J Pediatr Intensive Care. 2015;4(2):111-120. doi:10.1055/s-0035-1559806

2. Kyle UG, Jaimon N, Coss-Bu JA. Nutrition Support in Critically Ill Children: Underdelivery of Energy and Protein Compared with Current Recommendations. J Acad Nutr Diet. 2012;112 (12):1987-1992. doi:10.1016/j.jand.2012.07.038

3. Bagri NK, Jose B, Shah SK, Bhutia TD, Kabra SK, Lodha R. Impact of Malnutrition on the Outcome of Critically Ill Children. Indian J Pediatr. 2015;82(7):601-605. doi:10.1007/s12098-015-1738-y

4. Teka SG, Kebede RA, Sherman C. The prevalence of malnutrition during admission to the pediatric intensive care unit, a retrospective cross-sectional study at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Pan Afr Med J. 2022;41:77. doi:10.11604/pamj.2022.41.77.31284

5. Moreno YMF, Ventura JC, Oliveira LD de A, Silveira TT, Hauschild DB. Undernutrition in critically ill children. Pediatr Med. 2020;3(0). doi:10.21037/pm-20-66

6. Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017; 41(5):706-742. doi:10.1177/0148607117711387

7. Albadi MS, Bookari K. Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review. Front Pediatr. 2022;10: 769401. doi:10.3389/fped.2022.769401

8. Altintas ND, Aydin K, Türkoğlu MA, Abbasoğlu O, Topeli A. Effect of Enteral Versus Parenteral Nutrition on Outcome of Medical Patients Requiring Mechanical Ventilation. Nutr Clin Pract. 2011;26(3):322-329.
doi:10.1177/0884533611405790

9. Kratochvíl M, Klučka J, Klabusayová E, et al. Nutrition in Pediatric Intensive Care: A Narrative Review. Children. 2022;9(7):1031. doi:10.3390/children9071031

10. Irving SY, Albert BD, Mehta NM, Srinivasan V. Strategies to optimize enteral feeding and nutrition in the critically ill child: a narrative review. Pediatr Med. 2022;5:9-9. doi:10.21037/pm-21-6

11. Jamieson NC, Tadi P. Feeding Tube. In: StatPearls. StatPearls Publishing; 2024. Accessed June 2, 2024.
http://www.ncbi.nlm.nih.gov/books/NBK559044/

12. Tume LN, Valla FV, Joosten K, et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med. 2020;46 (3):411-425. doi:10.1007/s00134-019-05922-5

13. Hulst JM, Goudoever JB van, Zimmermann LJI, et al. The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population. Clin Nutr. 2004;23(6): 1381-1389. doi:10.1016/j.clnu.2004.05.006

14. Mehta NM, Bechard LJ, Zurakowski D, Duggan CP, Heyland DK. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study1. Am J Clin Nutr. 2015;102(1):199-206. doi:10.3945/ajcn.114.104893

15. Ribeiro LMK, Oliveira Filho RS, Caruso L, Lima PA, Damasceno NRT, Soriano FG. Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors? Rev Bras Ter Intensiva. 2014;26(2). doi:10.5935/0103-507X.20140023

16. Wanden-Berghe C, Patino-Alonso MC, Galindo-Villardón P, Sanz-Valero J. Complications Associated with Enteral Nutrition: CAFANE Study. Nutrients. 2019;11(9):2041. doi:10.3390/nu11092041

17. Simakachorn N, Bibiloni R, Yimyaem P, et al. Tolerance, Safety, and Effect on the Faecal Microbiota of an Enteral Formula Supplemented With Pre‐ and Probiotics in Critically Ill Children. J Pediatr Gastroenterol Nutr. 2011;53(2):174-181. doi:10.1097/MPG.0b013e318216f1ec

18. Evans S, Daly A, Davies P, MacDonald A. Fibre content of enteral feeds for the older child. J Hum Nutr Diet. 2009;22(5):414-421. doi:10.1111/j.1365-277X.2009.00991.x

19. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr Edinb Scotl. 2019;38(1):48-79. doi:10.1016/j.clnu.2018.08.037

20. Marvin RG, McKinley BA, McQuiggan M, Cocanour CS, Moore FA. Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection. Am J Surg. 2000; 179(1):7-12. doi:10.1016/S0002-9610(99)00261-5