Association between enteral feeding and gastrointestinal complications in children receiving extracorporeal life support: A retrospective cohort study

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.