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Enteral Nutrition Improves Vital Signs in Children With Bronchiolitis on Noninvasive Ventilation
Anthony A Sochet1,2, Miranda Nunez3, Michael J Wilsey4,5
1Divisions of Critical Care Medicine, anthony.sochet@jhmi.edu.
Insights
Enteral nutrition (EN) during noninvasive ventilation (NIV) in children with bronchiolitis was associated with reduced respiratory rate and heart rate. This practice appears safe and may alleviate distress in pediatric patients.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Clinical nutrition
Background:
- Enteral nutrition (EN) practices vary widely for children hospitalized with bronchiolitis who require noninvasive ventilation (NIV).
- Assessing the impact of EN on key physiological parameters during NIV is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the effect of initiating enteral nutrition on heart rate (HR) and respiratory rate (RR) in pediatric patients with bronchiolitis receiving noninvasive ventilation.
- To determine the safety and potential benefits of EN in this vulnerable patient population.
Main Methods:
- A retrospective cohort study was conducted on children under 2 years old hospitalized for bronchiolitis and receiving NIV.
- Physiometric indices (HR and RR) were measured before and after EN initiation. Descriptive statistics and paired comparative analyses were used.
Main Results:
- Of 124 children, 85 received EN, showing significant reductions in median RR ( -11%) and HR (-5%) post-initiation.
- Younger children and those with bronchopulmonary dysplasia were more likely to receive EN.
- No significant differences were observed in malnutrition rates, comorbidities, or length of stay; importantly, no aspiration events occurred.
Conclusions:
- Initiating enteral nutrition in children with bronchiolitis on NIV led to decreased respiratory and heart rates without significant aspiration.
- These findings support the safety and potential therapeutic benefit of EN in reducing patient distress during NIV.
Objectives:
In children hospitalized for bronchiolitis, enteral nutrition (EN) practices during noninvasive ventilation (NIV) vary widely. We sought to assess the potential impact of EN by observing changes in physiometric indices (heart rate [HR] and respiratory rate [RR]) before and after EN initiation.
Methods:
We performed a retrospective cohort study in children <2 years of age hospitalized for bronchiolitis receiving NIV from 2017 to 2019 in a quaternary ICU. The primary outcome was patient HR and RR before and after EN initiation. Descriptive data included demographics, anthropometrics, comorbidities, NIV parameters, EN characteristics, and general hospital outcomes. Analyses included paired comparative and descriptive statistics.
Results:
Of the 124 children studied, 85 (69%) were permitted EN at a median of 12 (interquartile range [IQR]: 7 to 29) hours. The route was oral (76.5%), nasogastric (15.3%), or postpyloric (8.2%) and was predominantly started during high-flow nasal cannula (71%) at flow rates of 1 (IQR: 0.7 to 1.4) L/kg per minute. After EN initiation, reductions in the median RR (percentage change: -11 [IQR: -23 to 3]; P < .01) and HR (percentage change: -5 [IQR: -12 to 1]; P < .01) were noted. Those permitted EN were younger (5 [IQR: 2 to 11] vs 11 [IQR: 3 to 17] months; P < .01) and more likely to have bronchopulmonary dysplasia (19% vs 5%; P = .04). Malnutrition rates, comorbidities, admission timing, flow rates, length of stay, and NIV duration did not differ for those provided or not provided EN. No aspiration events were observed.
Conclusions:
Reductions between pre- and postprandial RR after EN initiation among children hospitalized for bronchiolitis on NIV were observed without clinically significant aspiration. These findings support existing data that suggest that EN is safe during NIV and may lessen distress in some patients.
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