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Published on: August 19, 2020
Risk Factors for Delayed Enteral Nutrition in Critically Ill Children
Michael F Canarie1, Suzanne Barry, Christopher L Carroll
11Department of Pediatrics, Yale University School of Medicine, New Haven, CT. 2Department of Pediatric Critical Care, Nemours/AI duPont Hospital for Children, Wilmington, DE. 3Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT. 4Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, NY. 5Division of Pediatric Critical Care Medicine, Department of Pediatrics, Maria Fareri Children's Hospital, Valhalla, NY. 6Department of Pediatrics, University of Massachusetts Memorial Medical Center, Worcester, MA. 7Division of Critical Care, Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.
Insights
Delayed enteral nutrition in critically ill children, often due to ventilation or illness severity, is linked to failure in achieving full nutrition. Identifying risk factors is key to improving outcomes for pediatric intensive care unit patients.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Healthcare outcomes research
Background:
- Delayed enteral nutrition (EN) in pediatric intensive care units (PICUs) is associated with poor outcomes.
- Understanding risk factors for delayed EN is crucial for improving nutritional support in critically ill children.
Purpose of the Study:
- To review nutritional practices in medical-surgical PICUs.
- To determine risk factors associated with delayed enteral nutrition in critically ill children.
Main Methods:
- Retrospective cross-sectional study utilizing medical records.
- Included children under 21 admitted to six northeastern US PICUs for ≥72 hours (excluding abdominal surgery patients).
- Analyzed data on time to EN initiation and associated risk factors.
Main Results:
- A total of 444 children were studied; 19.8% experienced delayed EN (≥48 hours post-admission).
- Risk factors for delayed EN included noninvasive ventilation, invasive positive-pressure ventilation, higher illness severity scores, procedures, and gastrointestinal disturbances.
- Delayed EN correlated with a failure to achieve full EN during PICU stay.
Conclusions:
- Most patients in the study received EN within 48 hours.
- Noninvasive positive-pressure ventilation was the strongest predictor of delayed EN.
- Further prospective research is needed to understand risk factors and optimize nutritional assessments.
Objective:
Delayed enteral nutrition, defined as enteral nutrition started 48 hours or more after admission to the PICU, is associated with an inability to achieve full enteral nutrition and worse outcomes in critically ill children. We reviewed nutritional practices in six medical-surgical PICUs and determined risk factors associated with delayed enteral nutrition in critically ill children.
Design:
Retrospective cross-sectional study using medical records as source of data.
Setting:
Six medical-surgical PICUs in northeastern United States.
Patients:
Children less than 21 years old admitted to the PICU for 72 hours or more excluding those awaiting or recovering from abdominal surgery.
Measurements And Main Results:
A total of 444 children with a median age of 4.0 years were included in the study. Enteral nutrition was started at a median time of 20 hours after admission to the PICU. There was no significant difference in time to start enteral nutrition among the PICUs. Of those included, 88 children (19.8%) had delayed enteral nutrition. Risk factors associated with delayed enteral nutrition were noninvasive (odds ratio, 3.37; 95% CI, 1.69-6.72) and invasive positive-pressure ventilation (odds ratio, 2.06; 95% CI, 1.15-3.69), severity of illness (odds ratio for every 0.1 increase in pediatric index of mortality 2 score, 1.39; 95% CI, 1.14-1.71), procedures (odds ratio, 3.33; 95% CI, 1.67-6.64), and gastrointestinal disturbances (odds ratio, 2.05; 95% CI, 1.14-3.68) within 48 hours after admission to the PICU. Delayed enteral nutrition was associated with failure to reach full enteral nutrition while in the PICU (odds ratio, 4.09; 95% CI, 1.97-8.53). Nutrition consults were obtained in less than half of the cases, and none of the PICUs used tools to assure the adequacy of energy and protein nutrition.
Conclusions:
Institutions in this study initiated enteral nutrition for a high percentage of patients by 48 hours of admission. Noninvasive positive-pressure ventilation was most strongly associated with delay enteral nutrition. A better understanding of these risk factors and assessments of nutritional requirements should be explored in future prospective studies.
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