Nutrition Support During Pediatric Extracorporeal Membrane Oxygenation

Farr, Bethany J.; Rice-Townsend, Samuel E.; Mehta, Nilesh M.

doi:10.1002/ncp.10212

Cited by 19 publications

(27 citation statements)

References 41 publications

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“…The provision of nutrition in children supported on ECMO has proved challenging because of the lack of a feasible method to estimate nutritional requirements, concurrent use of inotropes and concerns for gut ischemic injury, and lack of robust data to guide nutritional practices. This is further compounded by altered energy requirements and metabolic derangements in this critically ill population ( 4 ). Deleterious effects from overfeeding and underfeeding are well-documented.…”

Section: Introductionmentioning

confidence: 99%

Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

et al. 2021

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Extracorporeal membrane oxygenation (ECMO) support is increasingly utilized in quaternary pediatric intensive care units. Metabolic derangements and altered nutritional requirements are common in critically ill children supported on ECMO. However, there remains no consensus on the optimal approach to the prescription of nutrition in these patients. This narrative review aims to summarize the current medical literature on various aspects of nutrition support in pediatric patients on ECMO. These include: (1) nutritional adequacy, (2) pros and cons of feeding on ECMO, (3) enteral vs. parenteral nutrition, and (4) proposed recommendations and future directions for research in this area.

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Section: Introductionmentioning

confidence: 99%

Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

et al. 2021

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“…Adequate nutritional support may contribute to improve the prognosis of critically ill children including those on ECMO ( 5 , 9 ). Enteral route is the preferred method to deliver artificial nutrition in PICU since it has multiple advantages ( 18 ), but due to a variety of barriers, parenteral nutrition is often employed as a sole mode of nutrient delivery or as supplementary.…”

Section: Discussionmentioning

confidence: 99%

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Pérez

Gonzalez

Zamora

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives: To assess the safety of enteral nutrition (EN) in children on extracorporeal membrane oxygenation (ECMO). To describe nutritional status and the characteristics of the nutritional support in this population. Methods: A retrospective single-center analysis (2006–2016) including children <18 years on ECMO. Demographic data, nutritional status, characteristics of nutritional support, and development of gastrointestinal (GI) complications were recorded. Results: One hundred children, with a median age of 9.7 months (interquartile range [IQR] 3.9–63.1) were enrolled. Undernutrition was prevalent among children on ECMO (33.3%) mainly in patients <2 years ( P = 0.042). Most patients (64%) received EN at some point during ECMO therapy. EN was administered in the first 48 hours after ECMO initiation (48HEN) to 60.3% of the children. Mortality rate in the Pediatric Intensive Care Unit was lower in patients who received EN as the initial artificial nutrition support (ANS) (37.7 vs 51%, P = 0.005) and in children on 48HEN (34% vs 50%, P = 0.04). In the logistic regression analysis, duration of ECMO support and low cardiac output indication were the only factors associated with mortality. Although most patients on ECMO (45%) developed digestive complications, they were mostly mild, being constipation the most prevalent. In the logistic regression analysis, EN was not associated with an increase in GI complications ( P = 0.09). Only three patients developed intestinal ischemia (one without EN and two on EN). Conclusions: Undernutrition is prevalent among children on ECMO, mainly in infants <2 years. EN is not associated with severe gastrointestinal complications or higher mortality in these children.

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“…Providing optimal nutrition to critically ill children is also an important aspect of a favorable outcome. There were few nutritional support studies in pediatric patients who received ECMO even though they were nutritionally vulnerable ( 24 , 25 ). A prior retrospective study showed that early enteral feeding was associated with a lower hospital mortality rate ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Children With Extracorporeal Membrane Oxygenation in a Developing Country: An 11-Year Single-Center Experience

et al. 2021

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Introduction: Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure for patients with refractory cardiac or respiratory failure. The indications for ECMO are growing, and it is increasingly being used to support cardiopulmonary failure in children. However, the risks and benefits of ECMO should be weighed before deploying it on the patients. The objectives of this study were to identify the mortality risk factors and to determine the ECMO outcomes.Methods: The retrospective chart reviews were done for all patients aged 1 day−20 years old receiving ECMO between January 2010 and December 2020.Results: Seventy patients were enrolled in the study. The median age was 31.3 months. The incidence of VA and VV ECMO was 85.7 and 14.3%, respectively. The most common indication for ECMO was the failure to wean off cardiopulmonary bypass after cardiac surgery. Pre-existing acute kidney injury (OR 4.23; 95% CI 1.34–13.32, p = 0.014) and delayed enteral feeding (OR 3.85, 95% CI 1.23–12.02, p = 0.020), and coagulopathy (OD 12.64; 95% CI 1.13–141.13, p = 0.039) were associated with the higher rate of mortality. The rates of ECMO survival and survival to discharge were 70 and 50%, respectively.Conclusion: ECMO is the lifesaving tool for critically ill pediatric patients. Pre-existing acute kidney injury, delayed enteral feeding, and coagulopathy were the potential risk factors associated with poor outcomes in children receiving ECMO. However, ECMO setup can be done successfully in a developing country.

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Nutrition Support During Pediatric Extracorporeal Membrane Oxygenation

Cited by 19 publications

References 41 publications

Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Clinical Characteristics and Outcomes of Children With Extracorporeal Membrane Oxygenation in a Developing Country: An 11-Year Single-Center Experience

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