A Retrospective Study of Complications of Enteral Feeding in Critically Ill Children on Noninvasive Ventilation

Area of Science:

• Pediatric Critical Care Medicine
• Pediatric Respiratory Medicine
• Pediatric Gastroenterology

Background:

• Noninvasive ventilation (NIV) use is increasing in pediatric intensive care units (PICUs) for respiratory failure.
• Guidelines recommend early enteral nutrition (EN) within 24-48 hours, but its safety and impact on complications remain debated.
• Concerns about respiratory and gastric complications hinder early EN initiation in PICU patients on NIV.

Purpose of the Study:

• To evaluate the association between early enteral nutrition (EN) and the development of complications in pediatric patients receiving noninvasive ventilation (NIV).
• To assess the safety and impact of initiating EN within 48 hours of admission for acute respiratory failure in children.

Main Methods:

• Retrospective study of 332 pediatric patients (0-18 years) requiring NIV for acute respiratory failure.
• Comparison of complication rates between patients receiving EN within 48 hours and those not.
• Multivariate analysis to identify factors associated with complications.

Main Results:

• 75% of patients received EN within 48 hours; these patients had fewer respiratory complications (29% vs 72%, p < 0.01) and later onset (2 days vs 0 days, p < 0.01).
• Complications were mainly related to oxygenation needs (76%).
• Factors associated with complications included BiPAP use, higher FiO2, and lower SpO2; complications prolonged ICU stay (11 vs 3 days).

Conclusions:

• Early enteral nutrition (EN) in pediatric patients on noninvasive ventilation (NIV) is associated with fewer respiratory complications.
• Initiating EN within 48 hours of admission appears safe and potentially beneficial, even in critically ill children.
• Further research should focus on optimizing EN timing and protocols for pediatric NIV patients to minimize complications and improve outcomes.