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Safety of Enteral Feedings in Critically Ill Children Receiving Vasoactive Agents
Apurva K Panchal1, Jennifer Manzi2, Susan Connolly2
1University of Kansas Medical Center, Kansas City, Kansas apurvapanchal@gmail.com.
Insights
Enteral feeding in pediatric intensive care patients receiving vasoactive agents showed no difference in gastrointestinal outcomes but a trend toward lower mortality. Further research is needed to confirm safety.
Area of Science:
- Pediatric intensive care
- Clinical nutrition
- Pharmacology
Background:
- Vasoactive agents (VAs) are critical for managing pediatric shock.
- Enteral feeding is often withheld due to concerns about gastrointestinal complications in critically ill children.
Purpose of the Study:
- To retrospectively evaluate the safety and impact of enteral feeding in children receiving vasoactive agents (VAs).
Main Methods:
- Retrospective analysis of 339 pediatric intensive care unit patients (1 month to 18 years) who received VAs.
- Patients were categorized into fed and nonfed groups.
- Gastrointestinal outcomes and mortality were compared between groups using statistical tests and logistic regression.
Main Results:
- The fed group (55%) was younger and had a trend toward lower mortality (6.9% vs 15.9%) compared to the nonfed group (45%).
- No significant difference in gastrointestinal outcomes was observed between the fed and nonfed groups.
- Mortality was significantly lower in the fed group (OR, 0.39; P < .01).
Conclusions:
- Enteral feeding in pediatric patients on vasoactive agents is associated with similar gastrointestinal outcomes and a tendency for reduced mortality.
- Prospective studies are recommended to definitively establish the safety of enteral nutrition in this vulnerable population.
Background:
The objective of this retrospective study was to evaluate the safety of enteral feeding in children receiving vasoactive agents (VAs).
Methods:
Patients aged 1 month to 18 years with a pediatric intensive care unit stay for ≥96 hours during 2007 and 2008 who received any VA (epinephrine, norepinephrine, vasopressin, milrinone, dopamine, and dobutamine) were included and categorized into fed and nonfed groups. Their demographics, clinical characteristics, type and dose of VA, and presence of gastrointestinal (GI) outcomes were obtained. GI outcomes were compared between the groups by the χ(2) test, Mann-Whitney test, and logistic regression.
Results:
In total, 339 patients were included. Of these, 55% were in the fed group and 45% in the nonfed group. Patients in the fed group were younger (median age, 1.05 vs 2.75 years, respectively; P < .001) and tended to have a lower Pediatric Index of Mortality 2 (PIM2) risk of mortality (ROM) than those in the nonfed group (median, 3.33% vs 3.52%, respectively; P = .106). Mortality was lower in the fed group than the nonfed group (6.9% vs 15.9%, respectively; odds ratio [OR], 0.39; 0.18-0.84; P < .01, 95% CI), while GI outcomes did not differ between the groups. The vasoactive-inotropic score (VIS) did not differ between the groups except on day 1 (P = .017). The ROM did not differ between the groups after adjusting for age, PIM2 ROM, and VIS on day 1 (OR, 0.58; 0.26-1.28; P = .18, 95% CI).
Conclusions:
Enteral feeding in patients receiving VAs is associated with no difference in GI outcomes and a tendency towards lower mortality. Prospective studies are required to confirm the safety of enteral feedings in patients receiving VAs.
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