Feeding Recovery in Post-PICU Patients: A Case Series in an Intensive Feeding Program
Tariq Almanaseer1, Ellen Hayhurst1, Jessica B Doorn2
1College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA.
Insights
Pediatric intensive care unit (PICU) survivors showed significant feeding improvements after intensive interdisciplinary behavioral treatment (IIBT). Over half became eligible for tube weaning, highlighting IIBT
Area of Science:
- Pediatric critical care medicine
- Pediatric gastroenterology
- Pediatric rehabilitation
Background:
- Pediatric intensive care unit (PICU) survival has improved, but many children develop post-intensive care syndrome in pediatrics (PICS-p).
- PICS-p often includes persistent feeding difficulties, impacting growth and quality of life.
- Intensive feeding programs (IFP), or intensive interdisciplinary behavioral treatment (IIBT), can reduce tube dependence and improve oral intake, but outcomes in PICU survivors need further study.
Purpose of the Study:
- To evaluate feeding outcomes in children with prior PICU admission who completed an intensive interdisciplinary behavioral treatment (IIBT) program.
- To assess improvements in oral intake, feeding behaviors, and nutritional status post-IIBT.
Main Methods:
- Retrospective case series of 16 children (0-18 years) admitted to HDVCH, Corewell Health, Grand Rapids, Michigan, who completed IIBT between 2007 and 2024.
- Data collected included demographics, PICU course (admission cause, complications, length of stay, ventilation, nutrition status), and IIBT outcomes (feeding modality, oral skills, malnutrition).
- Feeding outcomes were compared pre- and post-IIBT.
Main Results:
- Following IIBT, 58% of previously tube-fed patients became eligible for tube removal, and 44% transitioned to partial or full self-feeding.
- Problematic mealtime behaviors decreased significantly (45.7% to 9.9%), while oral acceptance (62% to 95%) and mouth clearance (59% to 96%) improved.
- Malnutrition prevalence decreased from 20% to 12% post-IIBT.
Conclusions:
- Children with prior PICU admission demonstrated substantial improvements in feeding and behavior during IIBT.
- Over half of participants achieved tube-weaning eligibility, indicating the program's effectiveness.
- Significant delays between PICU discharge and IIBT initiation suggest potential barriers to timely intervention.
Background/Objectives:
Survival after pediatric intensive care unit (PICU) admission has improved, yet many children experience post-intensive care syndrome in pediatrics (PICS-p), including persistent feeding difficulties that impair growth and quality of life. An intensive feeding program (IFP), also known as intensive interdisciplinary behavioral treatment (IIBT), reduces tube dependence and improves oral intake; however, outcomes in PICU survivors remain understudied. This study aimed to evaluate feeding outcomes in children with prior PICU admission who completed IIBT.
Methods:
This study was a retrospective case series of children (0-18 years) admitted to the HDVCH, Corewell Health, Grand Rapids, Michigan, who subsequently completed IIBT (from 2007 to 2024). Variables included demographics, PICU course (admission indication, complications, length of stay, ventilation, and nutrition status) and IIBT outcomes (feeding modality, oral skills, and malnutrition status). Feeding outcomes were compared pre- and post-IIBT.
Results:
Sixteen patients were included (62.5% female; mean age 1.44 ± 1.21 years). Primary PICU admission causes were post-operative recovery (68.8%) and acute respiratory failure (25%). PICU complications included acute respiratory failure (43.8%) and the need for respiratory support beyond baseline (62.5%). At PICU discharge, 75% remained tube-fed and 18.8% were malnourished. The mean time from PICU discharge to IIBT initiation was 641 ± 385 days. At IIBT baseline, 75% were tube-fed and all were non-self-feeders. Following IIBT completion (mean length of stay 4.8 ± 0.9 weeks), 58% of tube-fed patients achieved tube removal eligibility; 44% transitioned to partial or full self-feeding; problematic mealtime behaviors decreased (45.7% → 9.9%); oral acceptance improved (62% → 95%); and mouth clearance improved (59% → 96%). Malnutrition prevalence decreased (20% → 12%).
Conclusions:
Children with prior PICU admission demonstrated substantial feeding and behavioral improvement during IIBT participation, with over half achieving tube-weaning eligibility. The time from referral to program start reflects barriers that delay intervention.
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