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Why Delay? Early Enteral Nutrition in Pediatric Burn Patients Improves Outcomes
Niti Shahi1,2,3, Heather E Skillman4, Ryan Phillips1,3
1Division of Pediatric Surgery, Children's Hospital Colorado, Aurora.
Insights
Early enteral nutrition (EN) for pediatric burn patients within 4 hours of admission significantly reduces underfeeding and intensive care unit (ICU) length of stay (LOS). This early feeding approach is critical for recovery in children with severe burns.
Area of Science:
- Pediatric critical care
- Burn management
- Nutritional support
Background:
- Children with moderate to large burns experience hypermetabolism, increasing nutritional needs.
- Adequate nutrition is crucial for recovery in pediatric burn patients.
- Early enteral nutrition (EN) is vital for managing increased caloric and protein requirements.
Purpose of the Study:
- To evaluate the benefits of early EN (within 4 hours) versus late EN (≥ 4 hours) in pediatric burn patients.
- To determine if early EN is associated with improved nutritional intake, fewer complications, and shorter hospital stays.
- To assess the impact of early EN on pneumonia rates and overall length of stay.
Main Methods:
- Retrospective analysis of 132 pediatric patients with total body surface area (TBSA) burns ≥ 10% from 2011-2018.
- Patients were divided into early EN (≤ 4 hours) and late EN (≥ 4 hours) groups.
- Data collected from a prospectively maintained burn registry.
Main Results:
- The early EN group showed significantly lower rates of underfeeding during the first week (P = .014).
- Patients receiving early EN had a shorter Intensive Care Unit (ICU) length of stay (LOS) (P = .025).
- No significant differences were noted in pneumonia rates, overall calorie/protein intake, feeding complications, or hospital LOS between groups in this analysis.
Conclusions:
- Early EN initiation within 4 hours of admission in pediatric burn patients is associated with decreased underfeeding.
- Early EN is linked to a reduced ICU length of stay for pediatric burn patients.
- Protocols for early EN in burn patients with ≥ 10% TBSA are recommended for all pediatric burn centers.
Abstract:
Children who sustain moderate to large surface area burns present in a hypermetabolic state with increased caloric and protein requirements. A policy was implemented at our institution in 2017 to initiate enteral nutrition (EN) in pediatric burn patients within 4 hours of admission. The authors hypothesize that early EN (initiated within 4 hours of admission) is more beneficial than late EN (initiated ≥ 4 hours from admission) for pediatric burn patients and is associated with decreased rates of pneumonia, increased calorie and protein intake, fewer feeding complications, a shorter Intensive Care Unit (ICU) length of stay (LOS), and a reduced hospital LOS. Children who sustained a total body surface area (TBSA) burn injury ≥ 10% between 2011 and 2018 were identified in a prospectively maintained burn registry at Children's Hospital Colorado. Patients were stratified into two groups for comparison: early EN and late EN. The authors identified 132 pediatric burn patients who met inclusion criteria, and most (60%) were male. Approximately half (48%) of the study patients were in the early EN group. The early EN group had lower rates of underfeeding during the first week (P = .014) and shorter ICU LOS (P = .025). Achieving and sustaining adequate nutrition in pediatric burn patients with moderate to large surface area burn injuries are critical to recovery. Early EN in pediatric burn patients is associated with decreased underfeeding and reduced ICU LOS. The authors recommend protocols to institute feeding for patients with burns ≥ 10% TBSA within 4 hours of admission at all pediatric burn centers.
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