title: Timing of enteral feeding in cerebral malaria in resource-poor settings: a randomized trial.
abstract: BACKGROUND
  Early start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cerebral malaria in resource poor settings. We hypothesized that the risk of aspiration pneumonia might outweigh the potential benefits of earlier recovery and prevention of hypoglycaemia.
  
  
  RESULTS
  A randomized trial of early (day of admission) versus late (after 60 hours in adults or 36 hours in children) start of enteral feeding was undertaken in patients with cerebral malaria in Chittagong, Bangladesh from May 2008 to August 2009. The primary outcome measures were incidence of aspiration pneumonia, hypoglycaemia and coma recovery time. The trial was terminated after inclusion of 56 patients because of a high incidence of aspiration pneumonia in the early feeding group (9/27 (33%)), compared to the late feeding group (0/29 (0%)), p = 0.001). One patient in the late feeding group, and none in the early group, had hypoglycaemia during admission. There was no significant difference in overall mortality (9/27 (33%) vs 6/29 (21%), p = 0.370), but mortality was 5/9 (56%) in patients with aspiration pneumonia.
  
  
  CONCLUSIONS
  In conclusion, early start of enteral feeding is detrimental in non-intubated patients with cerebral malaria in many resource-poor settings. Evidence gathered in resource rich settings is not necessarily transferable to resource-poor settings.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN57488577.
authors: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors: Richard J
authors: RJ
authors: Maude
authors: Gofranul
authors: G
authors: Hoque
authors: Mahtab Uddin
authors: MU
authors: Hasan
authors: Abu
authors: A
authors: Sayeed
authors: Shahena
authors: S
authors: Akter
authors: Rasheda
authors: R
authors: Samad
authors: Badrul
authors: B
authors: Alam
authors: Emran Bin
authors: EB
authors: Yunus
authors: Ridwanur
authors: R
authors: Rahman
authors: Waliur
authors: W
authors: Rahman
authors: Romal
authors: R
authors: Chowdhury
authors: Tapan
authors: T
authors: Seal
authors: Prakaykaew
authors: P
authors: Charunwatthana
authors: Christina C
authors: CC
authors: Chang
authors: Nicholas J
authors: NJ
authors: White
authors: M Abul
authors: MA
authors: Faiz
authors: Nicholas P J
authors: NP
authors: Day
authors: Arjen M
authors: AM
authors: Dondorp
authors: Amir
authors: A
authors: Hossain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001459:Bangladesh; D002648:Child; D003128:Coma / Q000150:complications; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006295:Health Resources / Q000600:supply & distribution*; D006761:Hospitals / Q000600:supply & distribution; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D016779:Malaria, Cerebral / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000150:complications; D013997:Time Factors