What’s the Hold Up? Factors That Delay Enteral Feeding in Hospitalized Patients

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As veterinarians, we know that undernutrition has numerous negative effects on our patients that stretch far beyond body condition scores and muscle mass. Several studies have documented that early enteral feeding can improve patient outcomes; yet in their recent JAVMA study, Drs. Maria Jugan and Leah Freilich found that nutritional intervention through enteral supplementation is frequently delayed. Read on for their retrospective assessment of clinical and hospital factors associated with timing of nutritional intervention, specifically feeding tube placement in hospitalized dogs and cats.

After completing this study, would you recommend any clinical changes to a veterinarian’s approach to nasogastric or esophageal tube placement?

Dr. Freilich: I would encourage all veterinarians to include nutrition as a key component of their treatment plan as it can be easily overlooked. There is evidence to suggest that having detailed instructions for feeding or caloric intake for a hospitalized patient will improve our ability to assess whether a patient requires supplemental enteral nutrition.

The data point out several differences in case management of enteral nutrition for cats and dogs (e.g., the median time to initial feeding tube placement following hospitalization was shorter by 1 day for cats). Did you find any differences surprising?

Dr. Freilich: We didn’t find the difference in time to initial feeding too surprising as we think most veterinarians are aware of the metabolic idiosyncrasies of cats and the danger of hepatic lipidosis, prompting quicker responses to prolonged inappetence in this species. Same with the difference in feeding tube type—it might be more expected that cats will continue to need nutritional support at home, leading to more immediate placement of an e-tube, without progression from an initial NG tube.

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What is the most important takeaway from this study?

Dr. Freilich: The most important aspect of this study might be just the act of looking for factors that delay enteral nutrition. Publishing factors that delay the placement of feeding tubes in one hospital may prompt other clinicians or hospitals to critically evaluate how and when they are choosing to place feeding tubes, including many small factors that can be addressed simply through awareness. It also serves as a reminder to consider the amount of time that a pet hasn’t eaten before hospitalization when forming inpatient nutrition plans.

What remains the biggest deficit in this area of research on enteral nutrition supplementation for dogs and cats?

Dr. Freilich: A big question in this field is how early enteral nutrition affects the outcome of cases and, conversely, how does malnutrition affect the outcome of cases?

What is the biggest limitation of this study?

Dr. Freilich: The retrospective nature of the study is a limitation, and we did not assess case outcome. Whether the delayed enteral nutrition affects the outcome of the case is not something we are able to comment on with this study. We also couldn’t assess whether there were other patient factors or owner decisions that prevented earlier enteral nutritional support.

Editor’s Note: This article is an excerpt from the Research Wrapped monthly newsletter. Subscribe here for free.

Is there anything you would like our readers to learn or know from your study that has not been mentioned?

Dr. Freilich: Placement of both NG tubes and e-tubes is something that can readily be performed by general practitioners, so inability to refer to a specialty hospital should not be a limitation to the application of these findings.

The Study

Retrospective evaluation of enteral nutrition supplementation in 295 hospitalized dogs and cats (2014-2023).

Freilich L, Jugan MC. JAVMA.
doi:10.2460/javma.24.07.0494