Enteral Feeding Practices in Infants With Congenital Heart Disease Across European PICUs: A European Society of Pediatric and Neonatal Intensive Care Survey*

Tume, Lyvonne N; Balmaks, Reinis; Cruz, Eduardo M. da; Latten, Lynne; Verbruggen, Sascha; Valla, Frédéric V.

doi:10.1097/pcc.0000000000001412

Cited by 55 publications

(54 citation statements)

References 36 publications

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“…Feeding protocols and adherence of clinical staff to these protocols can promote these practices (Mehta et al, ). The strength of our study was having an enteral feeding protocol in place, which seems to be unique compared with a recent survey among 59 European paediatric intensive care units (Tume et al, ). Only 39% of these units reported having specific written guidelines in place for feeding postoperatively, and only 30% of these units stated that all infants are routinely fed within 12–24 h after surgery (Tume et al, ).…”

Section: Discussionmentioning

confidence: 99%

High‐energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial

Zhang

et al. 2018

Nursing in Critical Care

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Background Previous studies have shown that feeding a high‐energy formula (HF) to infants after cardiac surgery increases energy intake, with fewer side effects on cardiopulmonary function. However, impacts on weight gain and gastrointestinal function remain unclear. Aims and objectives To determine the impact of HF compared with standard formula on weight gain and gastrointestinal tolerance in postoperative infants with congenital heart disease. Design This was a randomized controlled trial. Methods The setting of the study was at a 20‐bed cardiac intensive care unit at a tertiary children's hospital in China. Study population included infants <1 year of age who underwent cardiac surgery and were allocated to the intervention group (n = 32) or control group (n = 32). The intervention group received HF (100 kcal/100 mL), and the control group received standard formula (67 kcal/100 mL) for 7 days during the stabilized postoperative period at the cardiac intensive care unit. Primary outcomes were weight gain and gastrointestinal intolerance. Secondary outcomes were energy intake and standard intensive care characteristics. Results Infants who received HF (n = 30) showed less weight loss than those who received standard formula (n = 29); −16 g [95% confidence interval (CI): −74 to 42] versus −181 g (95% CI: −264 to −99), P = 0·001. The evaluation of gastrointestinal intolerance showed that the intervention group had several side effects, such as abdominal distension (n = 1), gastric retention (n = 2) and diarrhoea (n = 1), while the control group had no problems. Enteral energy intake in the intervention group was higher than the control group from day three. Conclusion Infants after cardiac surgery fed with HF gained more weight but had increased feeding intolerance. However, the feeding intolerance symptoms could be relieved by medication and did not affect feeding advancement. Relevance to clinical practice Paediatric intensive care clinicians should consider gradually increasing the energy density of the formula during feeding and assess feeding intolerance signs in some children with malnutrition after cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

High‐energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial

Zhang

et al. 2018

Nursing in Critical Care

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“…Definitions of feeding intolerance in critically ill patients found in the literature search Surveys of PICU healthcare professionals (nurses, physicians, and dieticians) reveal a number of commonly used signs and symptoms to define feeding intolerance [16,40,43,44]. These include gastric residual volumes (GRV), vomiting, diarrhea, abdominal distention and pain/discomfort, and the use of serum lactate [41,46].…”

Section: Resultsmentioning

confidence: 99%

“…We did not formally appraise the quality of these papers, as our aim was to describe the definition and use of the term feeding intolerance. A further 32 papers were review or discussion papers [n = 6] [2, 6,13,18,46,47], surveys [n = 5] [16,40,41,43,44], research papers which support this review but are not included in papers which defined feeding intolerance [n = 19] [3, 8, 11, 12, 14, 15, 17, 24, 25, 27, 30-32, 36, 38, 39, 42, 49], and guidelines [n = 2] [4,26] where feeding intolerance was mentioned or discussed.…”

Section: Resultsmentioning

confidence: 99%

“…However, due to fears around suboptimal tissue perfusion, serum lactate in particular is frequently used as an indicator to delay or withhold enteral feeding. Although increased lactate indicates inadequate tissue perfusion, using it as a maker to stop or withhold feeds is problematic and subjective, as variable lactate thresholds are used [43]. In the PICU context, lactate is likely to be used as a feeding intolerance predictor, rather than a feeding intolerance sign.…”

Section: Markers Of Systematic Tissue Perfusionmentioning

confidence: 99%

“…Serum lactate is a commonly used factor to determine inadequate tissue perfusion [43], but other methods of tissue perfusion assessment, such as splanchnic near-infrared spectroscopy, are possible, though used rarely [12,43]. However, due to fears around suboptimal tissue perfusion, serum lactate in particular is frequently used as an indicator to delay or withhold enteral feeding.…”

Section: Markers Of Systematic Tissue Perfusionmentioning

confidence: 99%

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A review of feeding intolerance in critically ill children

Tume

Valla

2018

Eur J Pediatr

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Ensuring optimal nutrition is vital in critically ill children and enteral feeding is the main route of delivery in intensive care. Feeding intolerance is the most commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition, yet the definition for this remains inconsistent, nebulous, and entirely arbitrary. Not only does this pose problems clinically, but research in this field frequently uses feeding intolerance as an endpoint and the heterogeneity in this definition makes the comparison of studies difficult and meta-analysis impossible. We reviewed the use of, and definitions of, the term feed intolerance in pediatric intensive care research papers in the last 20 years. Gastric residual volume remains the most common factor used to define feed intolerance, despite the lack of evidence for this. Healthcare professionals would benefit from further education to improve their awareness of the limitations of the markers to define feeding intolerance, and the international PICU community needs to agree a consistent definition of this phenomenon to improve consistency in both practice and research.Conclusion: This paper will provide a narrative review of the definitions of, evidence for, and markers of feeding intolerance in critically ill children.

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Energy and Protein Requirements in Children Undergoing Cardiopulmonary Bypass Surgery: Current Problems and Future Direction

Zhang

Cui

et al. 2018

J Parenter Enteral Nutr

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Congenital heart disease (CHD) is 1 of the most common congenital malformations, and considerable numbers of infants and young children with CHD undergo cardiopulmonary bypass surgery. It has been increasingly realized that perioperative nutrition support plays an important role in improving clinical outcomes. The purpose of this review, by searching PubMed, was to examine the nutrition conditions in perioperative children with CHD and the main problems in nutrition management in the cardiac intensive care unit (CICU), based on which future directions were proposed. We found that preoperative poor nutrition status is common. This limited reserve of energy and protein is further compounded by the complex metabolic alterations with hypermetabolism, hypercatabolism, and hypoanabolism in the early postoperative course. Knowledge about energy and protein metabolism and requirements in children after cardiopulmonary bypass remains very limited. The current nutrition recommendations in the CICU are based on little evidence. Insufficient energy and protein supply to meet demands remains a norm in the immediate postoperative period. The commonly used predictive equations do not provide accurate estimate of energy requirement in individual patients during the highly dynamic postoperative course. Indirect calorimetry can provide the best estimate of energy requirements for children with CHD in the CICU. Measurement of nitrogen balance is the recommended method to determine the minimal protein requirement. During the early postoperative period, daily measurements of resting energy expenditure using indirect calorimetry and nitrogen balance in each individual child are essential to optimize energy and protein supply to meet requirements.

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Enteral Feeding Practices in Infants With Congenital Heart Disease Across European PICUs: A European Society of Pediatric and Neonatal Intensive Care Survey*

Abstract: Wide variations in practices exist in the nutritional care between European PICUs, which reflects the absence of local protocols and scientific society-endorsed guidelines. This is likely to contribute to suboptimal energy delivery in this particularly vulnerable group.

Cited by 55 publications

References 36 publications

High‐energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial

High‐energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial

A review of feeding intolerance in critically ill children

Energy and Protein Requirements in Children Undergoing Cardiopulmonary Bypass Surgery: Current Problems and Future Direction

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