Enteral (NG/PEG) Nutrition
In recent years, research has increased on the use of feedings by either a nasogastric (NG), or a percutaneous endoscopic gastrostomy (PEG) tube as an alternative to parenteral (intravenous) nutrition. This is mostly attributed to decreasing the cost of medical care, and increasing safety. A NG tube is passed through the nose to the stomach or jejunum, and the PEG requires a surgical procedure to implant it through the abdomen into the stomach. Sometimes, the tube will be advanced into the jejunum for added safety and tolerance.
However, it should not be assumed that the metabolic complications of parenteral nutrition will be avoided by use of enteral nutrition, nor is it without risk. The most common risks include tube displacement, pulmonary aspiration and poor patient tolerance. Many women with HG have slow emptying of their stomachs, extremely sensitive gag reflexes, and frequent vomiting which make NG feedings intolerable and somewhat risky. Some of these women report repeated tube dislodgements due to vomiting. Further, many women benefit greatly from a period of gut rest, yet require nutritional support due to weeks of vomiting and limited intake. Intravenous nutrition is preferred initially in these women.
Research & Risks
A few studies have demonstrated that enteral nutrition may be a safe and effective alternative to TPN in selected pregnant women with HG who have failed conventional treatment. However, these studies have only a few patients of varying severity, and thus should be interpreted cautiously. It is not yet clear as to which women with HG are the best candidates. It should be noted that women with HG have several risk factors for aspiration, as well as Refeeding Syndrome, both potential complications of enteral nutrition (see below for more info). Careful monitoring is important when initiating this therapy. In women who continue to vomit, more aggressive antiemetics should be considered, and/or an alternative mode of nutritional support.
Risk Factors for Aspiration:
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Patient's at Risk for Refeeding Syndrome:
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Adapted from http://www.rxkinetics.com/tpntutorial/2_3.html, www.medscape.com, and other sources. |
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Updated on: Sep. 15, 2022