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Association between goal nutrition and intubation in patients with bronchiolitis on noninvasive ventilation: A
Sabrina Huq1, Rajat Pareek1, Alicia Stowe2
1Pediatric Critical Care Medicine, Helen DeVos Children's Hospital/Corewell Health, Grand Rapids, Michigan, USA.
Insights
Achieving goal energy intake in hospitalized children with bronchiolitis on noninvasive ventilation was linked to significantly lower intubation rates. This supports early enteral nutrition for better outcomes in pediatric respiratory illness.
Area of Science:
- Pediatric critical care medicine
- Neonatal and pediatric nutrition
Background:
- Acute bronchiolitis is a common cause of hospitalization in young children.
- Enteral nutrition is beneficial but often withheld during noninvasive respiratory support due to aspiration concerns.
- Hypothesis: Goal energy intake reduces intubation risk in ventilated bronchiolitis patients.
Purpose of the Study:
- To examine the association between achieving goal enteral nutrition and intubation rates in hospitalized children with bronchiolitis requiring noninvasive ventilation.
Main Methods:
- Retrospective cohort study of 272 children with bronchiolitis.
- Compared intubation rates between patients meeting goal energy intake (60% of dietary reference energy) and those not meeting it.
- Used stratified analysis by respiratory support level and feeding route.
Main Results:
- 215 out of 272 patients met goal feeds; groups had similar demographics.
- Intubation rate was 4.65% in the goal-feeds group vs. 24.6% in the non-goal-feeds group (P < 0.0001).
- This association persisted after controlling for respiratory status, feed initiation time, and feeding route.
Conclusions:
- Achieving goal energy intake is associated with lower intubation rates in pediatric bronchiolitis patients on noninvasive ventilation.
- No increased aspiration rates were observed in patients meeting goal energy intake.
- Potential confounding factors include practice variations and unmeasured illness severity.
Background:
Acute bronchiolitis causes many hospitalizations in children younger than 2 years. Early enteral nutrition is associated with improved outcomes in these patients. However, often nutrition is withheld when patients require noninvasive respiratory support because of the risk of aspiration worsening respiratory failure, possibly requiring intubation. We hypothesize that achieving goal energy intake is associated with a lower intubation rate in hospitalized children with bronchiolitis who require noninvasive ventilation.
Methods:
This retrospective cohort study examined the association between goal enteral nutrition (60% of dietary reference energy intake) and intubation rates. We grouped patients by severity of illness and compared intubation rates in those who met goal energy to those who did not. We use stratified analysis methods (for both level of respiratory support and feeding route) to evaluate progression to intubation.
Results:
Of the 272 patients, 215 met goal feeds. These groups had similar demographics, but the goal-feeds group started on higher respiratory support in the pediatric intensive care unit. We found that 4.65% of the patients who met goal feeds required intubation compared with 24.6% of patients who did not meet goal feeds (P < 0.0001), even after controlling for respiratory status at admission and time of feed initiation and feeding route.
Conclusion:
We observed when adjusting for severity, feeding route, and respiratory support, achieving goal energy intake remained associated with a lower rate of intubation, without higher rates of aspiration. Confounding factors include practice variation and difference in severity of illness that objective scoring may have missed.
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