Enteral Nutrition During Noninvasive Ventilation in the PICU: Single-Center Retrospective Study, 2019-2023

To evaluate our practice and complications of enteral nutrition (EN) in pediatric patients supported with noninvasive positive pressure ventilation (NIPPV), excluding high-flow nasal cannula.

Retrospective study.

Single PICU in a tertiary children's hospital.

We included children (birth to 18 yr old) who were admitted between January 2019 and June 2023 and who received at least 24 hours of NIPPV. We excluded patients on home NIPPV, those dependent on parenteral nutrition, and those undergoing abdominal pathology, which precluded using EN.

None.

We characterized and evaluated our PICU patients on NIPPV and analyzed the associated odds of initiating EN. Characteristics analyzed included age, duration and type of NIPPV, route of EN delivery, time to initiate and reach goal EN, use of sedation, and preceding intubation during admission. Complications reviewed included emesis, aspiration, radiograph exposure for feeding tube placement, intubation, and death. Overall, there were 512 separate episodes of NIPPV of which 204 required EN with about two-thirds via a post-pyloric feeding tube. Initiation of EN occurred by a median of 24 hours of NIPPV and goal calories were reached by a median of 39 hours. After multivariable analysis, episodes of NIPPV associated with greater odds of EN had medical complexity and longer NIPPV duration. Age 1 year young or younger was associated with greater odds of using EN. Emesis occurred in 36 NIPPV episodes, and there were only three aspiration events. In all episodes of NIPPV, use of EN was associated with longer PICU and hospital lengths of stay.

EN is often limited in children receiving NIPPV. In our single-center review, few complications were noted when providing EN to children during NIPPV. As use continues to increase, further research is warranted to clarify the role of EN and its relationship to length of stay while on NIPPV.