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Enteral Feeding of Children on Noninvasive Respiratory Support: A Four-Center European Study
Lyvonne N Tume1,2, Renate D Eveleens3, Juan Mayordomo-Colunga1,2,3,4,5,6,7,8,9,9,10,11
1School of Health and Society, University of Salford, Manchester, United Kingdom.
Insights
Children on noninvasive respiratory support achieved 56% of energy goals, with variations in feeding practices across European pediatric intensive care units. Further trials are needed to optimize nutrition delivery for these vulnerable patients.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Respiratory support
Background:
- Enteral feeding is crucial for critically ill children.
- Optimizing nutrition delivery in children requiring noninvasive respiratory support is challenging.
- Variations in practice exist across pediatric intensive care units (PICUs).
Purpose of the Study:
- To investigate enteral feeding practices.
- To assess the achievement of energy targets in children on noninvasive respiratory support.
- To identify factors influencing energy delivery in four European PICUs.
Main Methods:
- Retrospective cohort study across four European PICUs.
- Included 325 children requiring acute noninvasive respiratory support within the first 7 days of admission.
- Primary outcome: achievement of standardized caloric goals; secondary outcomes: feeding methods, time to feeds, gastrointestinal complications.
Main Results:
- Children received a median of 56% of their energy goals.
- High-flow nasal cannula was the most common support (43.6%), followed by bilevel positive airway pressure (33.2%) and continuous positive airway pressure (21.2%).
- Gastric feeding was common (77.8%), with continuous feeds and certain modes of respiratory support associated with better energy target achievement.
Conclusions:
- Children on noninvasive respiratory support tolerated enteral feeding with low rates of serious complications.
- Significant variations in feeding practices and energy delivery were observed between centers.
- Prospective studies are necessary to establish optimal timing and methods for enteral feeding in this population.
Objectives:
To explore enteral feeding practices and the achievement of energy targets in children on noninvasive respiratory support, in four European PICUs.
Design:
A four-center retrospective cohort study.
Setting:
Four PICUs: Bristol, United Kingdom; Lyon, France; Madrid, Spain; and Rotterdam, The Netherlands.
Patients:
Children in PICU who required acute noninvasive respiratory support in the first 7 days. The primary outcome was achievement of standardized kcal/goal.
Interventions:
None.
Measurements And Main Results:
A total of 325 children were included (Bristol 104; Lyon 99; Madrid 72; and Rotterdam 50). The median (interquartile range) age and weight were 3 months (1-16 mo) and 5 kg (4-10 mo), respectively, with 66% admitted with respiratory failure. There were large between-center variations in practices. Overall, 190/325 (58.5%) received noninvasive respiratory support in order to prevent intubation and 41.5% after extubation. The main modes of noninvasive respiratory support used were high-flow nasal cannula 43.6%, bilevel positive airway pressure 33.2%, and continuous positive airway pressure 21.2%. Most children (77.8%) were fed gastrically (48.4% continuously) and the median time to the first feed after noninvasive respiratory support initiation was 4 hours (interquartile range, 1-9 hr). The median percentage of time a child was nil per oral while on noninvasive respiratory support was 4 hours (2-13 hr). Overall, children received a median of 56% (25-82%) of their energy goals compared with a standardized target of 0.85 of the recommended dietary allowance. Patients receiving step-up noninvasive respiratory support (p = < 0.001), those on bilevel positive airway pressure or continuous positive airway pressure (compared with high-flow nasal cannula) (p = < 0.001), and those on continuous feeds (p = < 0.001) achieved significantly more of their kcal goal. Gastrointestinal complications varied from 4.8-20%, with the most common reported being vomiting in 54/325 (16.6%), other complications occurred in 40/325 (12.3%) children, but pulmonary aspiration was rare 5/325 (1.5%).
Conclusions:
Children on noninvasive respiratory support tolerated feeding well, with relatively few complications, but prospective trials are now required to determine the optimal timing and feeding method for these children.
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