调查：人工营养存在缺陷

There are major deficiencies in the way hospitals provide artificial nutrition to sick babies and adults, an inquiry¹ has found.

一项调查发现，医院向生病的婴儿和成年人提供人工营养的方式有很多缺陷。

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Artificial feeding is for those who cannot absorb food via the gut

A national safety watchdog found problems in three quarters of the intravenous（静脉内的） feeding it cases examined.

Complications were avoidable in half the adult patients reviewed, it said.

Premature³ babies meanwhile were not always given the sustenance⁴（食物，生计） they needed, and delays were rife⁵（普遍的，流行的） , the report added.

The report from the National Confidential⁶ Enquiry into Patient Outcome and Death (NCEPOD) looked at more than 1,000 cases of artificial - or parenteral - nutrition in England, Wales and Northern Ireland.

Liquid containing key nutrients⁷ pumped from a bag directly into a vein⁸ is given to patients who cannot digest food through the gut（肠子） as a result of disease or surgery, or babies whose systems are not mature enough.

Training

A catalogue of problems were uncovered while reviewing questionnaires（问卷，调查表） and case notes from England, Wales and Northern Ireland, the "Mixed Bag" report found.

They included failure to ensure the catheter was inserted by a trained clinician under suitably sterile⁹（无菌的） conditions, as well as lapses¹⁰（失效） in monitoring and assessment¹¹.

The report noted¹² that intravenous feeding can cause fatal problems if not properly administered - from failure to take in enough calories and vitamins to blood poisoning - although the team did not itself uncover any deaths.

But it also found that in almost a third of adult cases it was being given where other forms of feeding via the gut were possible, putting patients at risk unnecessarily.

"There's a broader lack of understanding and knowledge of how to feed patients," said Dr James Stewart, NCEPOD clinical co-ordinator.

"Doctors can panic, and think this is the easiest way to go about dealing¹³ with a sick patient. But it certainly isn't the easiest, and in some cases it is completely inappropriate."

The group is also calling for greater consensus¹⁴（一致，舆论） among neonatologists（新生儿学专家） about best practice for pre-term babies after uncovering a "lottery¹⁵（彩票） " in the way in which infants were treated.

Out of the 264 cases reviewed, there were delays in recognising the need for artificial feeding in a third of cases, and further delays in starting treatment once a decision has been taken.

In nearly 40% of cases, the first feeding provided was considered inadequate¹⁶ for the baby's need. Complications, it found, were avoidable in a fifth of the babies treated.