title: Early versus late enteral feeding in patients with acute cervical spinal cord injury: a pilot study.
abstract: METHODS
  A prospective randomized clinical pilot study to compare early versus late enteral feeding in patients with acute cervical spinal cord injury.
  
  
  OBJECTIVE
  To compare the incidence of infections in patients with acute cervical spinal cord injury who received early versus late enteral feeding. Secondary objectives included assessing nutritional status, feeding tolerance, the number of ventilator hours, and acute-care hospital length of stay.
  
  
  BACKGROUND
  Early nutritional support has been found to be beneficial in critically ill patients. However, the same benefits may not be realized in patients with acute cervical spinal cord injury because of their unique nutritional challenges.
  
  
  METHODS
  Eligible patients were randomized to early feeding (initiated before 72 hours after injury) and late (initiated more than 120 hours after injury). Patients were stratified on the basis of their neurologic level. Patients were assessed daily for the first 15 days. After that time, infections (according to Center for Disease Control criteria), ventilator hours, and length of acute-care hospital stay were tracked.
  
  
  RESULTS
  Twenty-three patients met the eligibility criteria, and 17 patients were included in the analysis. There were 7 patients in the early group and 10 in the late group. The early group had a mean of 2.4 +/- 1.5 infections compared with the late group, which had a mean of 1.7 +/- 1.1 infections. Secondary outcomes were not substantially different between the two groups.
  
  
  CONCLUSIONS
  This pilot study failed to detect any differences in the incidence of infection, nutritional status, feeding complications, number of ventilator hours, or length of stay between patients receiving early versus late initiation of enteral feeding. These data will assist in the determination of an adequate sample size for future studies.
authors.affiliation: Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada. mdvorak@vanhosp.bc.ca
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Noonan
authors.forename: Lise
authors.initials: L
authors.lastname: Bélanger
authors.forename: Birthe
authors.initials: B
authors.lastname: Bruun
authors.forename: Peter C
authors.initials: PC
authors.lastname: Wing
authors.forename: Michael C
authors.initials: MC
authors.lastname: Boyd
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
mesh_terms: D000208:Acute Disease; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications / Q000151:congenital* / Q000534:rehabilitation*; D009752:Nutritional Status; D010865:Pilot Projects; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D016896:Treatment Outcome