Late Nutrition and Negative Outcomes in a Brazilian Paediatric Intensive Care Unit: A Retrospective Cohort

To analyse the association between late initiation of enteral nutrition and negative outcomes in the Paediatric Intensive Care Unit (PICU) in Brazil.

This was a retrospective cohort study with data from the medical records of children hospitalised between 2012 and 2017. The independent variable was late initiation of enteral nutrition (> 24 h after admission). The outcomes analysed included longer length of stay in the PICU and hospital, incidence of healthcare-related infections (HAIs), and death. Poisson regression models with robust variance were adjusted for potentially confounding variables by presenting relative risks (RR) and 95% confidence intervals (95% CI).

We analysed 840 hospitalizations: 311 (37.0%) with delayed initiation of nutrition, 252 (30.0%) with a diagnosis of HAIs, and 93 deaths (11.1%). After all adjustments, late initiation of enteral nutrition was associated with longer lengths of stay in the PICU (RR: 1.41; 95% CI: 1.01-1.30), hospital stay (RR: 1.22; 95% CI: 1.06-1.41), and higher HAI incidence (RR: 1.40; 95% CI: 1.14-1.73). The association with mortality was no longer significant after adjusting for the admission severity indicators.

The results indicate that late initiation of nutrition can lead to longer PICU and hospital stays and a higher incidence of HAIs.