TY - JOUR
T1 - Association between enteral feeding and gastrointestinal complications in children receiving extracorporeal life support
T2 - A retrospective cohort study
AU - Tume, Lyvonne N.
AU - Beech, Gail
AU - Tse, Chi
AU - Nolan, Shirley
AU - Brady, Alison
AU - Odutolu, Yetunde
AU - Latten, Lynne
N1 - Publisher Copyright:
© 2023 The Authors. Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.
PY - 2023/6/18
Y1 - 2023/6/18
N2 - Background: Extracorporeal life support is an accepted treatment modality for children with severe cardiac and/or respiratory dysfunction. However, after a period of inadequate gut perfusion, clinicians are often reluctant to initiate enteral nutrition. Methods: This was a retrospective cohort study in a single large pediatric intensive care unit in North West England over 5.5 years (2017–2022). Results: One hundred fifty-six children, who had a median age of 2 months (IQR, 0.3–15) and a mean weight-for-age z score of –1.50 (SD, 1.7), were included. Indications for extracorporeal life support were respiratory failure (31%), cardiac arrest (28%), low cardiac output state (27%), and inability to separate from cardiopulmonary bypass (12%). Most (75%) children were fed during extracorporeal life support, with a median time to initiate feeding of 24 h (IQR, 12.2–42.7). More gastrointestinal complications were associated with being enterally fed (86% vs 14%; P < 0.001), but complications were predominantly feed intolerance (46%), which was associated with receiving formula feeds rather than maternal (breast) milk (P < 0.001). Overall, the proportion of children's median energy targets achieved by 72 h was 38% (IQR, 10.7%−76%), but this varied by support indication. Conclusions: Our findings suggest most children tolerated enteral feeding within 24 h after extracorporeal life support initiation, with only mild gastrointestinal complications.
AB - Background: Extracorporeal life support is an accepted treatment modality for children with severe cardiac and/or respiratory dysfunction. However, after a period of inadequate gut perfusion, clinicians are often reluctant to initiate enteral nutrition. Methods: This was a retrospective cohort study in a single large pediatric intensive care unit in North West England over 5.5 years (2017–2022). Results: One hundred fifty-six children, who had a median age of 2 months (IQR, 0.3–15) and a mean weight-for-age z score of –1.50 (SD, 1.7), were included. Indications for extracorporeal life support were respiratory failure (31%), cardiac arrest (28%), low cardiac output state (27%), and inability to separate from cardiopulmonary bypass (12%). Most (75%) children were fed during extracorporeal life support, with a median time to initiate feeding of 24 h (IQR, 12.2–42.7). More gastrointestinal complications were associated with being enterally fed (86% vs 14%; P < 0.001), but complications were predominantly feed intolerance (46%), which was associated with receiving formula feeds rather than maternal (breast) milk (P < 0.001). Overall, the proportion of children's median energy targets achieved by 72 h was 38% (IQR, 10.7%−76%), but this varied by support indication. Conclusions: Our findings suggest most children tolerated enteral feeding within 24 h after extracorporeal life support initiation, with only mild gastrointestinal complications.
KW - child
KW - extracorporeal membrane oxygenation
KW - intensive care
KW - neonate
KW - nutrition
KW - Medicine (miscellaneous)
KW - Nutrition and Dietetics
KW - Humans
KW - Extracorporeal Membrane Oxygenation/adverse effects
KW - Infant
KW - Treatment Outcome
KW - Gastrointestinal Diseases/etiology
KW - Retrospective Studies
KW - Enteral Nutrition/adverse effects
KW - Child
KW - Infant, Newborn
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U2 - 10.1002/jpen.2528
DO - 10.1002/jpen.2528
M3 - Article (journal)
C2 - 37255500
AN - SCOPUS:85162047143
SN - 0148-6071
VL - 47
SP - 729
EP - 735
JO - Journal of Parenteral and Enteral Nutrition
JF - Journal of Parenteral and Enteral Nutrition
IS - 6
ER -