Related Experiment Video
Updated: Jun 18, 2026
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit
Nilesh M Mehta1, Dianne McAleer, Susan Hamilton
1Division of Critical Care, Department of Anesthesia, Department of Nursing, Division of Gastroenterology, and Nutrition and Clinical Research Program, Biostatistics Core, at Children's Hospital Boston, Boston, Massachusetts 02115, USA. nilesh.mehta@childrens.harvard.edu
Insights
Enteral nutrition (EN) interruptions are frequent and often avoidable in critically ill children, impacting their ability to reach nutritional goals and increasing reliance on parenteral nutrition (PN). Addressing these barriers is key to optimizing nutrition delivery in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Nutrition
- Patient Safety
Background:
- Optimizing nutrient delivery is crucial for critically ill children.
- Enteral nutrition (EN) is the preferred route, but interruptions can hinder adequate intake.
- Understanding barriers to EN is essential for improving patient outcomes in the pediatric intensive care unit (PICU).
Purpose of the Study:
- To quantify nutrient intake in critically ill children.
- To identify risk factors for avoidable interruptions in EN.
- To highlight opportunities for improving EN delivery in a pediatric intensive care unit (PICU).
Main Methods:
- A 4-week observational study in a 29-bed tertiary PICU.
- Daily recording of nutrient intake and factors causing EN interruptions.
- Comparison of clinical characteristics and nutritional outcomes between patients with and without EN interruptions.
Main Results:
- 117 critically ill children were studied; 80 (68%) received EN.
- EN was interrupted in 24 (30%) patients, with 58% of episodes deemed avoidable.
- Avoidable EN interruptions were linked to increased parenteral nutrition (PN) use and delayed achievement of caloric goals, particularly in mechanically ventilated patients.
Conclusions:
- Enteral nutrition (EN) interruption is a common and frequently avoidable issue in critically ill children.
- Identifying and addressing barriers to EN delivery can optimize nutritional support in the PICU.
- Improved EN practices can lead to better patient outcomes and reduced reliance on PN.
Objective:
To describe nutrient intake in critically ill children, identify risk factors associated with avoidable interruptions to enteral nutrition (EN), and highlight opportunities to improve enteral nutrient delivery in a busy tertiary pediatric intensive care unit (PICU). Design, Setting, and Measurements: Daily nutrient intake and factors responsible for avoidable interruptions to EN were recorded in patients admitted to a 29-bed medical and surgical PICU over 4 weeks. Clinical characteristics, time to reach caloric goal, and parenteral nutrition (PN) use were compared between patients with and without avoidable interruptions to EN.
Results:
Daily record of nutrient intake was obtained in 117 consecutive patients (median age, 7 years). Eighty (68%) patients received EN (20% postpyloric) for a total of 381 EN days (median, 2 days). Median time to EN initiation was less than 1 day. However, EN was subsequently interrupted in 24 (30%) patients at an average of 3.7 +/- 3.1 times per patient (range, 1-13), for a total of 88 episodes accounting for 1,483 hours of EN deprivation in this cohort. Of the 88 episodes of EN interruption, 51 (58%) were deemed as avoidable. Mechanically ventilated subjects were at the highest risk of EN interruptions. Avoidable EN interruption was associated with increased reliance on PN and impaired ability to reach caloric goal.
Conclusions:
EN interruption is common and frequently avoidable in critically ill children. Knowledge of existing barriers to EN such as those identified in this study will allow appropriate interventions to optimize nutrition provision in the PICU.
Related Concept Videos
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube through...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:28Chronic Kidney Disease III: Interprofessional Care
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic...