Early vs late enteral nutrition in pediatric intensive care unit: Barriers, benefits, and complications.
children
critical illness
enteral nutrition
intensive care unit
pediatrics
Journal
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
ISSN: 1941-2452
Titre abrégé: Nutr Clin Pract
Pays: United States
ID NLM: 8606733
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
revised:
08
09
2022
received:
10
02
2022
accepted:
24
09
2022
pubmed:
22
10
2022
medline:
17
3
2023
entrez:
21
10
2022
Statut:
ppublish
Résumé
This study aimed to define the existing barriers for early enteral nutrition (EEN) in critically ill children and to analyze the differences in nutrient supply, complications, and outcomes between EEN and late EN (LEN). This is a secondary analysis of a multicenter observational, prospective study including critically ill children receiving EN. Variables analyzed included demographic and anthropometric features, caloric and nutrient supply, outcomes, and complications according to the EN onset. Patients were classified into two groups according to the start of EN: 24-EEN vs EN started after 24 h (24-LEN) and 48-EEN vs EN started after 48 h (48-LEN). Sixty-eight children were enrolled; 22.1% received 24-EEN, and 67.6% received 48-EEN. EN was most frequently delayed in patients older than 12 months, in patients with cardiac disease, and in those requiring mechanical ventilation (MV). Children in the 24-EEN group had shorter duration of MV compared with those in the 24-LEN group (P = 0.04). The 48-EEN group received a higher caloric intake (P = 0.04), reached the caloric target earlier (P < 0.01), and had lower incidence of constipation (P = 0.01) than the 48-LEN group. There was a positive correlation between the time required to reach the maximum caloric intake and the length of pediatric intensive care stay (r = 0.46; P < 0.01). EEN may improve nutrient delivery, reduce time on MV, and prevent constipation in critically ill children. No relevant differences between 24-EEN and 48-EEN were found. Cardiac disease, MV, and age older than 12 months were risk factors associated with LEN.
Sections du résumé
BACKGROUND
BACKGROUND
This study aimed to define the existing barriers for early enteral nutrition (EEN) in critically ill children and to analyze the differences in nutrient supply, complications, and outcomes between EEN and late EN (LEN).
METHODS
METHODS
This is a secondary analysis of a multicenter observational, prospective study including critically ill children receiving EN. Variables analyzed included demographic and anthropometric features, caloric and nutrient supply, outcomes, and complications according to the EN onset. Patients were classified into two groups according to the start of EN: 24-EEN vs EN started after 24 h (24-LEN) and 48-EEN vs EN started after 48 h (48-LEN).
RESULTS
RESULTS
Sixty-eight children were enrolled; 22.1% received 24-EEN, and 67.6% received 48-EEN. EN was most frequently delayed in patients older than 12 months, in patients with cardiac disease, and in those requiring mechanical ventilation (MV). Children in the 24-EEN group had shorter duration of MV compared with those in the 24-LEN group (P = 0.04). The 48-EEN group received a higher caloric intake (P = 0.04), reached the caloric target earlier (P < 0.01), and had lower incidence of constipation (P = 0.01) than the 48-LEN group. There was a positive correlation between the time required to reach the maximum caloric intake and the length of pediatric intensive care stay (r = 0.46; P < 0.01).
CONCLUSION
CONCLUSIONS
EEN may improve nutrient delivery, reduce time on MV, and prevent constipation in critically ill children. No relevant differences between 24-EEN and 48-EEN were found. Cardiac disease, MV, and age older than 12 months were risk factors associated with LEN.
Types de publication
Observational Study
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
442-448Informations de copyright
© 2022 American Society for Parenteral and Enteral Nutrition.
Références
Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017;41(5):706-742.
Tume LN, Valla FV, Joosten K, et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med. 2020;46(3):411-425.
Nguyen NQ, Besanko LK, Burgstad C, et al. Delayed enteral feeding impairs intestinal carbohydrate absorption in critically ill patients. Crit Care Med. 2012;40(1):50-54.
McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract. 2009;24(3):305-315.
Kreymann KG, Berger MM, Deutz NE, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006;25(5):210-223.
Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Crit Care Med. 2016;44(2):390-438.
Solana MJ, Manrique G, Fernández R, et al. Nutritional status and nutrition support in critically ill children in Spain: results of a multicentric study. Nutrition. 2021;84:110993. doi:10.1002/ncp.10922
de Lucas C, Moreno M, López-Herce J, Ruiz F, Pérez-Palencia M, Carrillo A. Transpyloric enteral nutrition reduces the complication rate and cost in the critically ill child. J Pediatr Gastroenterol Nutr. 2000;30(2):175-180.
Pinilla JC, Samphire J, Arnold C, Liu L, Thiessen B. Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: a prospective, randomized controlled trial. JPEN J Parenter Enter Nutr. 2001;25(2):81-86.
Taylor RM, Preedy VR, Baker AJ, Grimble G. Nutritional support in critically ill children. Clin Nutr. 2003;22(4):365-369.
Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med. 2001;29(12):2264-2270.
Briassoulis GC, Zavras NJ, Hatzis MDTD. Effectiveness and safety of a protocol for promotion of early intragastric feeding in critically ill children. Pediatr Crit Care Med. 2001;2(2):113-121.
Briassoulis G, Tsorva A, Zavras N, Hatzis T. Influence of an aggressive early enteral nutrition protocol on nitrogen balance in critically ill children. J Nutr Biochem. 2002;13(9):560.
Khorasani EN, Mansouri F. Effect of early enteral nutrition on morbidity and mortality in children with burns. Burns. 2010;36(7):1067-1071.
Tume LN, Eveleens RD, Verbruggen SCAT, et al. Barriers to delivery of enteral nutrition in pediatric intensive care: a world survey. Pediatr Crit Care Med. 2020;21(9):e661-e671.
Canarie MF, Barry S, Carroll CL, et al. Risk factors for delayed enteral nutrition in critically ill children. Pediatr Crit Care Med. 2015;16(8):e283-e289.
Tume LN, Eveleens RD, Mayordomo-Colunga J, et al. Enteral feeding of children on noninvasive respiratory support: a four-center European study. Pediatr Crit Care Med. 2021;22(3):e192-e202.
Tume LN, Valla FV. Enteral feeding in children on noninvasive ventilation is feasible, but clinicians remain fearful. Pediatr Crit Care Med. 2017;18(12):1175-1176.
Tume L, Carter B, Latten LA. UK and Irish survey of enteral nutrition practices in paediatric intensive care units. Br J Nutr. 2013;109(7):1304-1322.
Sánchez C, López-Herce J, Mencía S, Urbano J, Carrillo A, María Bellón J. Clinical severity scores do not predict tolerance to enteral nutrition in critically ill children. Br J Nutr. 2009;102(2):191-194.
Bechard LJ, Parrott JS, Mehta NM. Systematic review of the influence of energy and protein intake on protein balance in critically ill children. J Pediatr. 2012(2);161:333-339.e1.
Srinivasan V, Hasbani NR, Mehta NM, et al. Early enteral nutrition is associated with improved clinical outcomes in critically ill children: a secondary analysis of nutrition support in the heart and lung failure-pediatric insulin titration trial. Pediatr Crit Care Med. 2020;21(3):213-221.
López J, Botrán M, García A, et al. Constipation in the critically ill child: frequency and related factors. J Pediatr. 2015;167(4):857-861.e1.
Rassameehiran S, Nugent K, Rakvit A. When should a patient with a nonvariceal upper gastrointestinal bleed be fed? South Med J. 2015;108(7):419-424.
Hurt RT, Frazier TH, McClave SA, et al. Stress prophylaxis in intensive care unit patients and the role of enteral nutrition. JPEN J Parenter Enteral Nutr. 2012;36(6):721-731.
MacLaren R, Jarvis CL, Fish DN. Use of enteral nutrition for stress ulcer prophylaxis. Ann Pharmacother. 2001;35(12):1614-1623.