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.

Citation

Tume, L., Eveleens, R., Mayordomo-Colunga, J., Lopez, J., Verbruggen, S., Fricaudet, M., …Valla, F. (2021). Enteral feeding of children on noninvasive respiratory support : a four-centre European study. Pediatric Critical Care Medicine, 22(3), e192-e202. https://doi.org/10.1097/PCC.0000000000002602

• 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/