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The administration of blended diet (BD), instead of commercial enteral formula was , until recently, considered out-with standard safe practice.1 BD is increasingly considered as an alternative strategy for feeding in patients with Gastrointestinal Dystonia (GID). There is limited data on NTBM in the long-term BD population. We aimed to retrospectively review NTBM for BD within our regional service and make recommendations for practice from this data.Patients commenced on BD between 1/1/17–1/5/24 were identified from five regional dietetic databases. Baseline demographics, diagnoses, patient complexity and the presence of GID were gathered. Patients were established on BD by local process which includes; dietetic assessment of nutritional requirements, risk assessment and an educational package. BD volumes were prescribed in combination with enteral feeds and titrated upwards as tolerated; individualised dietetic plans were reviewed for nutritional adequacy and adjusted via MDT forum. BD patients were defined as either full or partial BD (commercial enteral formula used in combination with BD). Local guidance recommends NTBM at baseline,6 months, and annually thereafter for; U+E, LFT, Bone Profile, PTH, Vitamins A, B12, D, E, zinc, copper, selenium, magnesium, FBC, ferritin and folate.2Patients were screened for inflammatory response using serum albumin and C-reactive protein.85 patients were established on BD. 25 (29%) of these patients had GID. 23 (27%) patients received concurrent vitamin supplementation. 65 patients received partial BD. 24 (28%) patients received full BD. 5 patients had NTBM as per guidelines, 44 patients had an initial set at 6 months, and 26 patients had an initial set 1 year after commencing BD. Abnormalities in NTBM identified ≥6 months after commencing BD are outlined in table 1.Abstract OC17 Table 1 Blood Indices (Number monitored) Abnormality (number of patients) Action (number of patients) Adjusted calcium (52) Mildly elevated (3)Mildly deficient (1) Alfacalcidol stopped (1)None (2)Dietary modification (1) Copper (43) Mild elevation (3)Mild deficiency (3) Monitored (3) - no actionSupplementation (1)None (2) Ferritin (48) Moderate-Severe deficiency (17) Dietary modification (2)Supplementation (15) Folate (37) Mild deficiency (2) Supplementation (2) Magnesium (34) Hypo/Hypermagnesemia (0) Plasma Selenium (42) Mild elevation (3)Mild deficiency (6) Not required - Red cell selenium normal (9) Vitamin A (42) Mild elevation (11) Dietary modification (2)None (9) Vitamin B12 (45) Mild elevation (12) None (12) Vitamin D (52) Insufficient (8)Mild deficiency (1) Supplementation (6)None (3) Vitamin E (39) Mild elevation (23) None (3)Not required - Vitamin E: cholesterol ratio normal (20) Zinc (38) Mild-moderate deficiency (11) Supplementation (2) The frequency and severity of NTBM abnormalities compare favourably with previous review of enteral or orally fed patients with neuro-disability.3 We postulate that these favourable outcomes with NTBM reflect careful patient selection and intensive dietetic support. Under this pathway, we postulate that routine NTBM for Vitamin E, Copper and Selenium are not required in BD, and that NTBM is required only annually if first NTBM are within normal limits. Whether adjuvant enteral formula alongside BD diet helps to normalise micronutrients, or if vitamin supplementation is required warrants further research.References Durnan S, Kennedy A, Kennedy D, Stanley R, Donohoe S, Thomas S, et al. Practice Toolkit: The Use of Blended Diet with Enteral Feeding Tubes. British Dietetic Association. 2021.NHS Quality Improvement Scotland. Best Practice Statement; Caring for children and young people in the community receiving enteral tube feeding. 2007.Brooks M, Paxton CE, Cardigan T, Wilson DC, Barclay AR. Regular blood monitoring for enterally fed children?: a systematic review. JPGN. 2014;Supp 1(58):S4.