Enteral feeding of children on noninvasive respiratory support : a four-centre European study

Tume, LN; Eveleens, R; Mayordomo-Colunga, J; Lopez, J; Verbruggen, S; Fricaudet, M; Smith, C; Garcia Cusco, M; Latten, L; Valla, FV

Abstract

Objective: To explore enteral feeding practices and the achievement of energy targets in children on Non-invasive respiratory support (NRS), in four European Pediatric Intensive Care Units (PICUs).
Design: A four centre retrospective cohort study
Setting: Four PICUs: Bristol UK, Lyon France, Madrid Spain, Rotterdam the Netherlands.
Patients: Children in PICU who required acute NRS in the first 7 days. The primary outcome was achievement of standardised kcal/goal.
Interventions: Nil
Measurements and Main Results: 325 children were included (Bristol 104; Lyon 99; Madrid 72; Rotterdam 50). The median (IQR) age and weight were 3 months (1-16) and 5 Kg (4-10) respectively, with 66% admitted with respiratory failure. There were large between-centre variations in practices. Overall, 190/325 (58.5%) received NRS in order to prevent intubation and 41.5% after extubation. The main modes of NRS used were high-flow nasal cannula 43.6%, bilevel positive airway pressure 33.2% and continuous positive airway pressure 21.2% Most children (77.8%) were fed gastrically (48.4% continuously) and the median time to first feed after NRS initiation was 4 hours (IQR 1-9). The median percentage of time a child was nil per oral whilst on NRS was 4 hours (2-13). Overall, children received a median of 56% (25%-82%) of their energy goals compared to a standardised target of 0.85 of the recommended dietary allowance. Patients receiving step-up NRS (p=<0.001), those on BLPAP or CPAP (compared to HFNC) (p =<0.001) and those on continuous feeds (p =<0.001) achieved significantly more of their kcal goal. GI complications varied from 4.8 – 20%, with the most common reported being vomiting in 54/325 (16.6%), other complications occurred in 40/325 (12.3%) children, but pulmonary aspiration was rare 5/325 (1.5%).
Conclusions: Children on NRS tolerated feeding well, with relatively few complications, but prospective trials are now required to determine the optimal timing and feeding method for these children.

• Journal Article Type: Article
• Acceptance Date: Sep 1, 2020
• Online Publication Date: Oct 21, 2020
• Publication Date: Mar 1, 2021
• Deposit Date: Sep 1, 2020
• Publicly Available Date: Oct 21, 2021
• Journal: Pediatric Critical Care Medicine
• Print ISSN: 1529-7535
• Electronic ISSN: 1947-3893
• Publisher: Lippincott, Williams & Wilkins
• Volume: 22
• Issue: 3
• Pages: e192-e202
• DOI: https://doi.org/10.1097/PCC.0000000000002602
• Publisher URL: https://doi.org/10.1097/PCC.0000000000002602
• Related Public URLs: http://www.pccmjournal.com/