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Enteral feeding intolerance: an indicator of sepsis-associated mortality in burned children
S E Wolf1, M G Jeschke, J K Rose
1Department of Surgery, University of Texas Medical Branch and the Shriners Burn Institute, Galveston 77550, USA. swolf@sbi.utmb.edu
Insights
Enteral feeding intolerance (EFI) in children with severe burns is linked to sepsis and higher mortality. Early identification of EFI can signal infection and prompt timely intervention in pediatric burn care.
Area of Science:
- Pediatric critical care medicine
- Burn injury management
- Infectious disease in pediatrics
Background:
- Severe burns in children pose significant risks, including the development of sepsis.
- Enteral feeding intolerance (EFI) is a common complication in critically ill pediatric patients.
- The relationship between EFI and sepsis in pediatric burn patients requires further elucidation.
Purpose of the Study:
- To investigate the association between enteral feeding intolerance (EFI) and sepsis in children with severe burns.
- To determine if EFI predicts increased mortality in this vulnerable pediatric population.
Main Methods:
- A survey-based study conducted in a pediatric burn unit.
- Included 91 children with >80% total body surface area burns surviving >5 days.
- Defined EFI by high gastric residuals or diarrhea; sepsis by positive blood cultures; and assessed mortality.
Main Results:
- Enteral feeding intolerance and sepsis were significantly associated (P<.001).
- Mortality rates were substantially higher in patients with EFI and/or sepsis compared to those without.
- EFI was identified in 70% of cases before sepsis was confirmed, with no predictive superiority over thrombocytopenia or hyperglycemia.
Conclusions:
- Enteral feeding intolerance is a significant indicator of sepsis and increased mortality in pediatric severe burn patients.
- EFI can serve as an early warning sign for infection, prompting a search for the source.
- Clinical vigilance for EFI is crucial in managing children with extensive burns.
Objective:
To determine if enteral feeding intolerance (EFI) is associated with sepsis and increased mortality in children with severe burns.
Design:
A survey.
Setting:
A pediatric burn unit.
Patients:
Ninety-one children surviving longer than 5 days with greater than 80% total body surface area burns.
Interventions:
None.
Main Outcome Measures:
Enteral feeding intolerance indicated by high gastric residuals (> 150 mL/h) or uncontrollable diarrhea (> 2500 mL/d); thrombocytopenia (platelet count < 100 x 10(9)/L); hyperglycemia (glucose level > 11.1 mmol/L [> 200 mg/dL]); sepsis (pathogenic bacteremia or fungemia noted on blood culture results); and mortality.
Results:
Neither EFI nor sepsis developed in 71 patients, EFI alone developed in 2 patients, sepsis alone developed in 5 patients, and EFI and sepsis developed in 13 patients. Enteral feeding intolerance and sepsis were associated by contingency table analysis (P<.001). Mortality was 8% (6 patients) in those with neither EFI nor sepsis, 50% (1 patient) in those with EFI alone, 60% (3 patients) in those with sepsis alone, and 77% (10 patients) in those with EFI-associated sepsis. The 2 latter groups were different from the group with neither EFI nor sepsis (P<.05). Enteral feeding intolerance was identified in 70% of patients before sepsis; thrombocytopenia, 64%; and hyperglycemia, 66%. When compared with thrombocytopenia and hyperthermia, no variables were found to be superior to others for predicting sepsis.
Conclusions:
Enteral feeding intolerance was associated with the development of sepsis and increased mortality in children with greater than 80% total body surface area burns. This sign was identified in 70% of the cases before pathogens were found in the blood; no difference could be shown between the identification of EFI, thrombocytopenia, and hyperglycemia before sepsis. These data indicate that the development of EFI should be used as an indicator of infection and should prompt a search for an inciting focus.