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Early enteral nutrition is associated with lower mortality in critically ill children
Theresa A Mikhailov1, Evelyn M Kuhn, Jennifer Manzi
1Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Early enteral nutrition (EEN) in critically ill children with prolonged PICU stays is linked to reduced mortality. While length of stay and mechanical ventilation duration may slightly increase, these changes are not statistically significant.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Outcomes research
Background:
- Critically ill children often require nutritional support.
- Early enteral nutrition (EEN) is defined as providing 25% of goal calories within 48 hours of admission.
- The impact of EEN on mortality and morbidity in pediatric intensive care unit (PICU) patients with prolonged stays requires further investigation.
Purpose of the Study:
- To investigate the association between early enteral nutrition (EEN) and mortality in critically ill children.
- To examine the relationship between EEN and morbidity, including length of stay (LOS) and duration of mechanical ventilation (MV).
- To assess EEN's impact on pediatric patients with a PICU LOS of at least 96 hours.
Main Methods:
- A multicenter retrospective study involving 12 PICUs.
- Inclusion criteria: patients aged 1 month to 18 years with a PICU LOS ≥96 hours (2007-2008).
- Data collected included demographics, PIM2 score, LOS, MV duration, mortality, and nutrition intake within the first 4 days.
Main Results:
- 5105 patients were analyzed; 27.1% received EEN.
- Children receiving EEN had significantly lower mortality (OR 0.51, P = .001) after adjustment.
- No significant differences in LOS (P = .59); a trend towards longer MV duration in EEN group (P = .058).
Conclusions:
- Early enteral nutrition (EEN) is strongly associated with reduced mortality in pediatric patients with prolonged PICU stays (≥96 hours).
- While LOS and MV duration may be slightly longer in patients receiving EEN, these differences did not reach statistical significance.
- Findings support the use of EEN in this patient population to improve survival outcomes.
Background:
The purpose of this study was to examine the association of early enteral nutrition (EEN), defined as the provision of 25% of goal calories enterally over the first 48 hours of admission, with mortality and morbidity in critically ill children.
Methods:
We conducted a multicenter retrospective study of patients in 12 pediatric intensive care units (PICUs). We included patients aged 1 month to 18 years who had a PICU length of stay (LOS) of ≥96 hours for the years 2007-2008. We obtained patients' demographics, weight, Pediatric Index of Mortality-2 (PIM2) score, LOS, duration of mechanical ventilation (MV), mortality data, and nutrition intake data in the first 4 days after admission.
Results:
We identified 5105 patients (53.8% male; median age, 2.4 years). Mortality was 5.3%. EEN was achieved by 27.1% of patients. Children receiving EEN were less likely to die than those who did not (odds ratio, 0.51; 95% confidence interval, 0.34-0.76; P = .001 [adjusted for propensity score, PIM2 score, age, and center]). Comparing those who received EEN to those who did not, adjusted for PIM2 score, age, and center, LOS did not differ (P = .59), and the duration of MV for those receiving EEN tended to be longer than for those who did not, but the difference was not significant (P = .058).
Conclusions:
EEN is strongly associated with lower mortality in patients with PICU LOS of ≥96 hours. LOS and duration of MV are slightly longer in patients receiving EEN, but the differences are not statistically significant.
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