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Clinical practice insight: vasoactive-inotropic drugs do not impede early enteral nutrition in pediatric ECMO support

Ye Ren1,2,3, Run Zhou1,2,3, Hongxing Dang1,2,3

  • 1Ministry of Education Key Laboratory of Child Development and Disorders, Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.

Frontiers in Nutrition
|October 29, 2025
PubMed

Insights

Vasoactive-inotropic drug use does not delay early enteral nutrition (EN) in pediatric ECMO patients. However, higher vasoactive-inotropic scores (VIS) correlate with lower energy delivery, necessitating closer hemodynamic monitoring for nutritional adequacy.

Area of Science:

  • Pediatric Critical Care Medicine
  • Neonatal and Pediatric Nutrition
  • Cardiovascular Support in Critically Ill Children

Background:

  • Early enteral nutrition (EN) is crucial for critically ill pediatric patients on extracorporeal membrane oxygenation (ECMO).
  • Vasoactive-inotropic drug use is common in ECMO patients and may impact nutritional delivery.
  • Optimizing energy intake is vital for recovery in this vulnerable population.

Purpose of the Study:

  • To investigate the impact of vasoactive-inotropic drug use on the early initiation of EN.
  • To determine if vasoactive-inotropic drug use affects energy intake adequacy in pediatric ECMO patients.
  • To identify predictors of suboptimal energy delivery in this cohort.

Main Methods:

  • A prospective observational cohort study of pediatric ECMO patients (June 2018-June 2024).
  • Patients were grouped by EN initiation time (≤48h vs >48h) and energy intake adequacy (<30% vs ≥30% target).
  • Vasoactive-Inotropic Score (VIS), PRISM III, EN interruptions, and energy intake were analyzed using Spearman correlation, Cohen's d, and SVM modeling.

Main Results:

  • Early EN (≤48h) was initiated in 67.2% of patients; VIS did not differ between early and delayed groups.
  • Delayed EN was linked to higher PRISM III scores, lower energy intake, and more interruptions.
  • Higher VIS on ECMO days 1 and 2 predicted suboptimal energy delivery (<30% target).

Conclusions:

  • Early EN initiation is feasible in pediatric ECMO patients even with vasoactive-inotropic drug support.
  • Elevated VIS within the first 48 hours is associated with inadequate energy delivery.
  • Close hemodynamic monitoring is essential to optimize nutritional support and adequacy in these patients.
Abstract

Keywords:
early enteral nutritionenergy intake adequacyextracorporeal membrane oxygenationpediatricsvasoactive-inotropic drugs

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