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Published on: January 17, 2025
Nutrition Provision in Children with Heart Disease on Extracorporeal Membrane Oxygenation (ECMO)
Jason S Kerstein1,2, Caroline R Pane1, Lynn A Sleeper1,2
1Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Insights
Providing adequate nutrition for pediatric heart patients on extracorporeal membrane oxygenation (ECMO) is crucial. While parenteral nutrition improved adequacy, it correlated with increased hospital-acquired infections, suggesting a need for optimized enteral nutrition strategies.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular research
- Nutritional science
Background:
- Nutrition management for pediatric patients requiring extracorporeal membrane oxygenation (ECMO) presents complex challenges.
- Optimizing energy and protein delivery is vital for clinical outcomes in critically ill children with heart disease.
Purpose of the Study:
- To examine nutrition provision in children with heart disease undergoing ECMO.
- To investigate the relationship between nutritional adequacy (energy and protein) and end-organ function (pSOFA scores).
Main Methods:
- Retrospective analysis of 259 ECMO runs in 252 pediatric patients (2013-2020).
- Assessment of median energy and protein delivery and adequacy (kcal/kg/day and g/kg/day).
- Evaluation of end-organ function using pediatric sequential organ failure assessment (pSOFA) scores.
Main Results:
- Median energy and protein adequacy were 58.3% and 35.7%, respectively.
- No significant association was found between nutritional adequacy and changes in pSOFA scores.
- Higher nutritional adequacy from parenteral nutrition correlated with increased hospital-acquired infections (HAIs).
Conclusions:
- Nutritional adequacy on ECMO was primarily achieved through parenteral nutrition.
- While parenteral nutrition improved adequacy, it was linked to a higher incidence of HAIs.
- Further research into optimal enteral nutrition strategies for pediatric ECMO patients is warranted to balance nutritional needs and infection risk.
Abstract:
Nutrition provision for children with heart disease supported with extracorporeal membrane oxygenation (ECMO) involves nuanced decision making. We examined nutrition provision while on ECMO in the CICU and the relationship between energy and protein adequacy and end organ function as assessed by pediatric sequential organ failure assessment (pSOFA) scores in children with heart disease supported with ECMO. Children (≤ 21 years-old) with congenital or acquired heart disease who received ECMO in the cardiac intensive care unit were included. There were 259 ECMO runs in 252 patients over an 8-year study period (2013-2020). Median energy delivery and adequacy were 26.1 [8.4, 45.9] kcal/kg/day and 58.3 [19.8, 94.6]%, respectively. Median protein delivery and adequacy were 0.98 [0.36, 1.64] g/kg/day and 35.7 [13.4, 60.3]%, respectively. pSOFA increased by a median of four points during the ECMO run. Change in pSOFA score was not associated with energy or protein adequacy (p = 0.46 and p = 0.72, respectively). Higher energy and protein adequacy-from parenteral nutrition-correlated with increased hospital-acquired infections (HAIs, p = 0.031 and p = 0.003, respectively). Achieving nutritional adequacy was dependent on the use of parenteral nutrition. Similar clinical outcomes with regard to end organ function but with an increased incidence of HAIs suggests the need to explore the role of optimal enteral nutrition delivery on ECMO.
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