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Published on: January 29, 2015
Association between enteral feeding guideline implementation and early enteral nutrition in children with critical
Sabrina Huq1, Rajat Pareek2, Kyle Knapp3
1Corewell Health East William Beaumont University Hospital, Royal Oak, Michigan, USA.
Insights
Implementing an enteral feeding guideline significantly increased early enteral nutrition for pediatric intensive care unit (PICU) patients with critical bronchiolitis on noninvasive ventilation. More patients achieved goal nutrition after the guideline
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Respiratory failure management
Background:
- Malnutrition is prevalent in pediatric intensive care units (PICUs).
- Enteral nutrition is often avoided in patients with respiratory failure due to aspiration risks.
- Lack of feeding guidelines in our PICU led to inconsistent nutrition delivery.
Purpose of the Study:
- To assess the impact of an enteral feeding guideline on early nutrition delivery.
- To determine if guideline implementation increased early enteral nutrition in critically ill infants.
- To evaluate the association between the guideline and achieving goal nutrition.
Main Methods:
- Retrospective study of pediatric patients (≤24 months) with critical bronchiolitis on noninvasive ventilation.
- Data collected from November 2017 to March 2020, with guideline implementation in June 2019.
- Primary outcome: >25% of dietary reference intake by 48 hours; Secondary outcome: >60% during admission.
Main Results:
- Early enteral nutrition achievement increased from 53% to 76% post-guideline (P < 0.001).
- Goal feed achievement rose from 75% to 84% (P = 0.057).
- The enteral feeding guideline was associated with improved nutrition delivery.
Conclusions:
- Implementation of an enteral feeding guideline improved early nutrition delivery.
- A greater proportion of patients with critical bronchiolitis achieved goal enteral nutrition.
- The guideline facilitated earlier feeding initiation and better nutritional outcomes.
Background:
Malnutrition is a common problem in the pediatric intensive care unit (PICU). Enteral nutrition is often withheld in patients with respiratory failure because of risk of aspiration and potential need for intubation, as seen in patients with critical bronchiolitis managed on noninvasive ventilation. Studies show that enteral nutrition guidelines improve feeding tolerance, reduce complications, and decrease time to optimal nutrition. Before June 2019, our PICU had no enteral feeding guidelines, leading to inconsistency with starting feedings and reaching goal nutrition. Our objective was to determine if there was an association between implementing an enteral feeding guideline and the percentage of patients with critical bronchiolitis on noninvasive ventilation who receive early enteral nutrition.
Methods:
A single-center retrospective study at a tertiary PICU provided the dataset for this study. We included patients with critical bronchiolitis aged ≤24 months, admitted to the PICU from November 2017 to March 2020, and managed on noninvasive ventilation. Our feeding guideline was implemented in June 2019. Our primary outcome was early enteral nutrition defined as achieving >25% of dietary reference intake by 48 h of PICU admission. Our secondary outcome was goal feeds defined as >60% of dietary reference intake during admission. We used chi-square analysis to analyze these data. Our institution's registered dietitians use dietary reference intake to calculate goal feeds.
Results:
With initiation of the enteral feeding guideline, the percentage of patients who met early enteral nutrition increased from 53% to 76% (P < 0.001), and those who reached goal feeds increased from 75% to 84% (P = 0.057).
Conclusion:
This study demonstrates that following implementation of the enteral feeding guideline, a greater proportion of patients with critical bronchiolitis on noninvasive ventilation started feeds earlier and achieved goal enteral nutrition during admission.
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