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Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review
Xenophon Theodoridis1, Lydia Chrysoula1, Kleo Evripidou1
1Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Insights
Continuous versus intermittent bolus enteral nutrition in critically ill children shows no significant difference in length of stay. Further research is needed to determine optimal feeding regimens for pediatric intensive care unit patients.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Nutrition
- Evidence-Based Medicine
Background:
- Enteral nutrition (EN) in critically ill pediatric patients is challenging due to complications and healthcare professional training gaps.
- Continuous and intermittent bolus feeding are common regimens, but literature reports barriers to their effective implementation.
- This review assesses the comparative effectiveness of continuous and intermittent bolus enteral feeding in pediatric intensive care units (PICU).
Approach:
- A systematic literature search was performed across major databases (PubMed, Scopus, CENTRAL) and clinical trial registries up to September 2022.
- Included were randomized controlled trials (RCTs) published in English, focusing on critically ill children in the PICU.
- Four RCTs involving 288 patients met the inclusion criteria, with varying risk of bias assessments.
Key Points:
- High heterogeneity was observed in outcome reporting across the included studies.
- Conflicting results were found regarding the time to reach prescribed caloric intake.
- No significant difference in length of stay (LOS) in PICU was detected between continuous and intermittent bolus feeding.
- One study suggested a potential benefit of bolus feeding for time to weaning from mechanical ventilation.
Conclusions:
- Current evidence comparing continuous and intermittent bolus enteral nutrition in critically ill children is limited and heterogeneous.
- Further high-quality randomized trials with robust methodology are required to definitively assess the efficacy of these feeding regimens.
- Data on key outcomes like gastric residual volume, anthropometric measurements, and biochemical markers were lacking.
Abstract:
Administration of enteral nutrition (EN) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) constitutes a major challenge due to the increased risk of complications, as well as the lack of well-trained healthcare professionals. EN is usually delivered via cyclic, continuous, or intermittent feeding; however, a number of potential barriers have been reported in the literature regarding different feeding regimens. The purpose of this review was to assess the effectiveness of continuous and intermittent bolus feeding on critically ill children. A systematic search was conducted in PubMed, Scopus Cochrane Central Register of Controlled Trials (CENTRAL) and a clinical trial registry up to September 2022, including randomized controlled trials (RCTs) published in the English language. Four studies met the inclusion criteria with a total population of 288 patients admitted to the PICU. Three studies were rated with a high risk of bias and one with some concerns. There was high heterogeneity between the studies in regard to the reporting of outcomes. Three studies measured the total time needed to reach prescribed caloric intake with conflicting results, while two studies evaluated the length of stay (LOS) in PICU with no difference between the two arms. One study assessed the time weaning from mechanical ventilation, favoring the bolus group. No data were provided for gastric residual volume (GRV), anthropometric measurements, and biochemical markers. Additional randomized trials with better methodology are needed to assess the efficacy of the two enteral feeding regimens in critically ill PICU patients.
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