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A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on
Ariann Lenihan1, Vannessa Ramos1, Nichole Nemec2
1Children's Hospital and Medical Center, Omaha, NE 68114, USA.
Insights
Early enteral nutrition is safe for infants with critical bronchiolitis on non-invasive respiratory support (NRS). Feeding these pediatric patients improved vital signs and did not increase complications, supporting early nutritional intervention.
Area of Science:
- Pediatric critical care medicine
- Neonatology and infant care
- Respiratory medicine
Background:
- Limited data on feeding pediatric patients with acute respiratory failure on non-invasive respiratory support (NRS).
- Acute respiratory failure in infants, often due to bronchiolitis, requires careful management including nutritional support.
Purpose of the Study:
- To investigate the safety and outcomes of enteral nutrition (EN) in pediatric patients with acute respiratory failure secondary to bronchiolitis managed on NRS.
- To evaluate the incidence of feeding-related complications and the impact of EN on clinical parameters.
Main Methods:
- Retrospective cohort study of 178 pediatric patients (up to 2 years) with critical bronchiolitis on NRS (CPAP, BiPAP, RAM cannula).
- Comparison of outcomes between patients receiving EN (n=114) and those nil per os (NPO) (n=64).
- Analysis of intubation rates, length of stay, feeding initiation timelines, complication rates, and vital sign changes.
Main Results:
- Patients receiving EN were younger; the NPO group had a higher intubation incidence.
- Early EN initiation (within 48h) and full feeds (within 7 days) were achieved in 90% and 94% of the EN group, respectively.
- Low complication (8%) and aspiration (<1%) rates were observed with EN, without escalation of respiratory support. Heart rate and respiratory rate significantly improved post-feeding.
Conclusions:
- Early enteral nutrition is a safe and potentially beneficial practice for pediatric patients with critical bronchiolitis requiring non-invasive respiratory support.
- EN in this population is associated with improved cardiorespiratory parameters and low complication rates.
- Findings support the integration of early nutritional support in the management of critically ill infants with respiratory failure on NRS.
Abstract:
Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to two years old with critical bronchiolitis managed on continuous positive airway pressure, bilevel positive airway pressure, or RAM cannula were included. Of the 178 eligible patients, 64 were reportedly nil per os (NPO), while 114 received enteral nutrition (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of stay in the pediatric intensive care unit and non-invasive respiratory support were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 h and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring NRS.
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