How to: Provide Assisted Enteral Nutrition

Introduction
In humans, malnutrition is associated with increased morbidity, increased risk of infection and prolonged hospitalisation, and early nutritional support of patients is commonplace. Although the effect of nutritional deficits in horses is less well understood, nutritional support is likely to be of benefit. Methods for nutritional support include provision of feedstuffs to horses willing and able to eat, assisted enteral nutrition (AEN) and parenteral nutrition (PN). In human medicine, while uncertainty remains as to whether AEN or PN provides superior clinical outcomes (Gramlich et al. 2004; Simpson and Doig 2005), early AEN has been associated with reduced patient morbidity and mortality. Data for direct comparison of AEN vs. PN in horses is not available to facilitate clinical decision making. However, AEN is cheaper, easier to administer, associated with fewer side effects, and likely supports physiological mechanisms (e.g. gastrointestinal function) and immunity. Enteral nutrition is associated with support of organ blood flow and function, maintenance of body condition, trophic stimulation of gastrointestinal tract (GIT) mucosa and preservation of the barrier function of the GIT mucosa to invasion of pathogenic microorganisms (Carr and Holcombe 2009). As such, in the patient that can tolerate enteral nutrition, this route is an intuitive selection for nutritional support in horses. [...]