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Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane
Gema Pérez1,2, Elena González1, Laura Zamora1
1Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón.
Insights
Enteral nutrition (EN) is safe for children on extracorporeal membrane oxygenation (ECMO), showing no increased risk of gastrointestinal complications or mortality. Undernutrition is common in this pediatric population, especially in infants.
Area of Science:
- Pediatric Critical Care Medicine
- Neonatology
- Pediatric Gastroenterology
Background:
- Children requiring extracorporeal membrane oxygenation (ECMO) often face nutritional challenges.
- Undernutrition is a significant concern in pediatric patients on ECMO, particularly those under two years old.
Purpose of the Study:
- To evaluate the safety and impact of enteral nutrition (EN) in children undergoing ECMO therapy.
- To describe the nutritional status and support characteristics in pediatric ECMO patients.
Main Methods:
- Retrospective analysis of 100 children (<18 years) treated with ECMO from 2006-2016.
- Data collected included demographics, nutritional status, enteral nutrition administration, and gastrointestinal (GI) complications.
- Statistical analysis, including logistic regression, was used to assess outcomes.
Main Results:
- Undernutrition affected 33.3% of pediatric ECMO patients, with higher prevalence in those under two years.
- 64% of patients received EN, with 60.3% initiated within 48 hours of ECMO.
- EN initiation was associated with lower PICU mortality (37.7% vs 51%). EN was not linked to increased GI complications (P=0.09).
Conclusions:
- Enteral nutrition is a safe nutritional support strategy for pediatric patients on ECMO.
- Initiating EN early in ECMO patients does not increase the risk of severe GI complications or mortality.
- Addressing undernutrition is crucial in pediatric ECMO care, especially for infants.
Objectives:
To assess the safety of enteral nutrition (EN) in children on extracorporeal membrane oxygenation (ECMO). To describe nutritional status and the characteristics of the nutritional support in this population.
Methods:
A retrospective single-center analysis (2006-2016) including children <18 years on ECMO. Demographic data, nutritional status, characteristics of nutritional support, and development of gastrointestinal (GI) complications were recorded.
Results:
One hundred children, with a median age of 9.7 months (interquartile range [IQR] 3.9-63.1) were enrolled. Undernutrition was prevalent among children on ECMO (33.3%) mainly in patients <2 years (P = 0.042). Most patients (64%) received EN at some point during ECMO therapy. EN was administered in the first 48 hours after ECMO initiation (48HEN) to 60.3% of the children.Mortality rate in the Pediatric Intensive Care Unit was lower in patients who received EN as the initial artificial nutrition support (ANS) (37.7 vs 51%, P = 0.005) and in children on 48HEN (34% vs 50%, P = 0.04). In the logistic regression analysis, duration of ECMO support and low cardiac output indication were the only factors associated with mortality.Although most patients on ECMO (45%) developed digestive complications, they were mostly mild, being constipation the most prevalent. In the logistic regression analysis, EN was not associated with an increase in GI complications (P = 0.09). Only three patients developed intestinal ischemia (one without EN and two on EN).
Conclusions:
Undernutrition is prevalent among children on ECMO, mainly in infants <2 years. EN is not associated with severe gastrointestinal complications or higher mortality in these children.
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