Adequate enteral feeding in the pediatric intensive care unit may be associated with fewer nosocomial infections and deaths

Joosten, Koen; Betue, Carlijn de

doi:10.1136/eb-2012-100974

Cited by 1 publication

(1 citation statement)

References 5 publications

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“…Compared with parenteral nutrition, EN may be easier to initiate, less costly and associated with lower risk of infection (5, 6). In addition, EN has been associated with improved nutritional indices and clinical outcomes including a nearly 4-fold decrease in mortality in critically ill, mechanically ventilated children (3, 7, 8).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Delayed Enteral Nutrition in Critically Ill Children*

Canarie

Barry

Carroll

et al. 2015

Pediatric Critical Care Medicine

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Objective Delayed enteral nutrition (EN), defined as EN started ≥ 48 hours after admission to the pediatric intensive care unit (PICU) is associated with an inability to achieve full EN and worse outcomes in critically ill children. We reviewed nutritional practices in 6 medical-surgical PICUs and determined risk factors associated with delayed EN in critically ill children. Design Retrospective cross-sectional study using medical records as source of data Setting Six medical-surgical PICUs in northeastern United States Patients Children < 21 years old admitted to the PICU for ≥ 72 hours excluding those awaiting or recovering from abdominal surgery. Measurements/Main Results A total of 444 children with a median age of 4.0 years were included in the study. EN was started at a median time of 20 hours after admission to the PICU. There was no significant difference in time to start EN among the PICUs. Of those included, 88 (19.8%) children had delayed EN. Risk factors associated with delayed EN were: non-invasive (odds ratio [OR]: 3.37; 95% CI: 1.69-6.72) and invasive positive pressure ventilation (OR: 2.06; 95% CI: 1.15-3.69), severity of illness, (OR for every 0.1 increase in Pediatric Index of Mortality 2 score: 1.39; 95% CI: 1.14-1.71) as well as procedures (OR 3.33; 95% CI: 1.67-6.64) and; gastrointestinal disturbances (OR: 2.05; 95% CI: 1.14-3.68) within 48 hours after admission to the PICU. Delayed EN was associated with failure to reach full EN while in the PICU (OR 4.09; 95% CI: 1.97-8.53). Nutrition consults were obtained in less than half of the cases and none of the PICUs employed tools to assure the adequacy of energy and protein nutrition. Conclusions Institutions in this study initiated EN for a high percentage of patients by 48 hours of admission. Non-invasive positive pressure ventilation was most strongly associated with delay EN. A better understanding of these risk factors and assessments of nutritional requirements should be explored in future prospective studies.

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