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Feeding during High-Flow Nasal Cannula for Bronchiolitis: Associations with Time to Discharge
Kristin A Shadman1, Michelle M Kelly1, M Bruce Edmonson1
1Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Insights
Feeding children during high-flow nasal cannula (HFNC) therapy for bronchiolitis may shorten hospital stays. Adverse events were rare, suggesting feeding is safe and beneficial for pediatric patients.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Neonatal and infant care
Background:
- High-flow nasal cannula (HFNC) is common for pediatric bronchiolitis.
- Optimal feeding practices during HFNC are unclear.
- Impact of feeding on discharge time and adverse events needs investigation.
Purpose of the Study:
- To determine if feeding during HFNC therapy affects hospital discharge time.
- To assess the association between feeding and adverse events in children with bronchiolitis.
Main Methods:
- Retrospective cohort study of 1-24 month olds receiving HFNC for bronchiolitis.
- Categorized feeding as fed (exclusively oral or mixed) or not fed.
- Primary outcome: time to discharge after HFNC cessation.
Main Results:
- 78% of children were fed during HFNC, 50% exclusively orally.
- Feeding was associated with a shorter time to discharge (HR 2.17).
- Adverse events like aspiration and intubation were infrequent.
Conclusions:
- Feeding children during HFNC for bronchiolitis may reduce time to discharge.
- Feeding-related adverse events were rare.
- Further controlled studies are needed to confirm findings and guide practice.
Background:
High-flow nasal cannula (HFNC) is increasingly used to treat children hospitalized with bronchiolitis; however, the best practices for feeding during HFNC and the impact of feeding on time to discharge and adverse events are unknown. The study objective was to assess whether feeding exposure during HFNC was associated with time to discharge or feeding-related adverse events.
Methods:
This retrospective cohort study included inpatients aged 1-24 months receiving HFNC for bronchiolitis at an academic children's hospital from January 1, 2015 to March 1, 2017. Feeding exposures during HFNC were categorized as fed or not fed. Among fed children, we further evaluated mixed (oral and tube) or exclusive oral feeding. The primary outcome was time to discharge after HFNC cessation. Secondary outcomes were aspiration, intubation after HFNC, and seven-day readmission.
Results:
Of 123 children treated with HFNC, 45 (37 %) were never fed. A total of 78 children (63%) were fed; 50 (41%) were exclusively orally fed and 28 (23 %) had mixed feeding. Median (interquartile range) time to discharge after HFNC was 29.5 hours (23.5-47.9) and 39.8 hours (26.4-61.5) hours in the fed and not fed groups, respectively. In adjusted models, time to discharge was shorter with any feeding (hazard ratio [HR] 2.17; 95% CI: 1.34-3.50) and with exclusive oral feeding (HR 2.13; 95% CI: 1.31-3.45) compared with no feeding. Time to discharge from HFNC initiation was shorter for exclusive oral feeding versus not feeding (propensity weighted HR 1.97 [95% CI: 1.13-3.43]). Adverse events (one intubation, one aspiration pneumonia, one readmission) occurred in both groups.
Limitations:
Assessment of feeding exposure did not account for quantity and duration.
Discussion:
Children fed while receiving HFNC for bronchiolitis may have shorter time to discharge than those not fed. Feeding-related adverse events were rare regardless of the feeding method. Controlled prospective studies addressing residual confounding are needed to justify a change in the current practice.
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