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Published on: October 24, 2018
Nutrition Delivery During Pediatric Extracorporeal Membrane Oxygenation Therapy
Lindsey B Armstrong1, Katelyn Ariagno2, Craig D Smallwood3
1Department of Surgery.
Insights
Parenteral nutrition (PN) is crucial for meeting energy and protein goals in pediatric extracorporeal membrane oxygenation (ECMO) patients within the first week. Early enteral nutrition (EN) is feasible but insufficient alone.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Neonatology
Background:
- Macronutrient delivery poses challenges in pediatric extracorporeal membrane oxygenation (ECMO) therapy.
- Understanding nutrient delivery predictors is vital for optimizing outcomes in critically ill children.
Purpose of the Study:
- To examine predictors of macronutrient delivery in the initial two weeks of pediatric ECMO.
- To identify factors influencing energy and protein intake in children on ECMO.
Main Methods:
- Retrospective analysis of 54 pediatric ECMO patients (newborn-18 years) surviving >24 hours.
- Data collection on macronutrient delivery (enteral and parenteral nutrition) within the first two weeks.
- Statistical analysis to identify predictors of nutrient delivery and associated outcomes.
Main Results:
- Optimal energy and protein delivery (>80% goal) by day 7 was achieved in 65% and 61% of patients, respectively.
- Parenteral nutrition (PN) was initiated early (day 1) in 87% of patients, while enteral nutrition (EN) was initiated later (day 6) in 94% of patients.
- Younger age and venoarterial ECMO mode were associated with lower EN delivery; late PN delivery correlated with nutrient deficits.
Conclusions:
- Most pediatric ECMO patients achieve optimal nutrient delivery by day 7, primarily through PN.
- Early EN is possible at low volumes, but PN is essential to prevent deficits in the first week.
- Timely PN initiation is critical for preventing cumulative energy and protein deficits in pediatric ECMO patients.
Background:
Macronutrient delivery during pediatric ECMO therapy can be challenging. We examined predictors of nutrient delivery in the first 2 weeks of extracorporeal membrane oxygenation (ECMO) therapy in the pediatric intensive care unit (ICU).
Methods:
Details of macronutrient delivery were recorded in children (newborn-18 years of age) who survived 24 hours after cannulation to ECMO over a 3-year period (2012-2015).
Results:
We analyzed data from 54 consecutive eligible patients, 43% female, with median (interquartile range) ECMO duration of 8.5 (6-24) days, age 0.1 (0, 16) months, ICU length of stay 32 (21, 60) days, and 28-day mortality 13%. Median weight for age z score declined from -0.1 at admission to -1.2 at 30 days (P = 0.013). At least 80% goal energy and protein was delivered in 35 (65%) and 33 (61%) patients, respectively, by day 7; 10% of energy and 11% protein goal was delivered enterally. Parenteral nutrition (PN) was utilized in 47 (87%) patients, initiated by day 1 (1, 3). Enteral nutrition (EN) was successfully delivered in 49 (94%) patients (35% postpyloric), initiated by day 6 (2, 16). Younger age (P = 0.01) and venoarterial mode of ECMO (P = 0.0014) were associated with lower EN delivery. Use of umbilical artery catheters or vasoactive infusions did not impede EN delivery. Late PN delivery was associated with cumulative protein deficits (P = 0.019) and failure to achieve nutrient delivery goals by day 7.
Conclusions:
Optimal nutrient delivery was achieved in most patients by day 7, predominantly via PN. Early EN is feasible in low volumes, but PN may be essential to prevent cumulative energy and protein deficits during the first week of ECMO.
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