Nutritional status, intake, and outcomes in critically ill children with bronchiolitis

Abstract

Background Optimal nutrition in children with severe bronchiolitis remains poorly described. We aimed to describe nutritional status and practices in children with severe bronchiolitis requiring admission to the pediatric intensive care unit (PICU), and explore their associations with outcomes. Methods We conducted a retrospective study on patients with bronchiolitis requiring PICU stay from 2009 to 2014. Demographics, medical data, and baseline weight‐for‐length Z‐scores (WLZ) were collected. In patients requiring more than 48 hours of PICU stay, nutritional intake data in the first 3 days of PICU stay were collected. Underfeeding and overfeeding were defined as the median energy intake of less than 80% and more than 120% of requirements, respectively. Protein adequacy was defined as intake of more than 1.5 g/kg/d. Primary and secondary outcomes of interest were the duration of PICU stay and mechanical ventilation (MV), respectively. Results Seventy‐four patients were included, with a median PICU stay of 4.9 days (interquartile range 2.0‐8.2). Low WLZ at baseline was associated with longer duration of PICU stay (adjusted β: 4.33 [95% confidence interval [CI], 0.49‐8.18]; P = .028) and MV days (adjusted β: 4.87 [95% CI, 1.56‐8.18]; P = .008) compared to appropriate WLZ. In patients with ≥48 hours PICU stay, protein adequacy was significantly associated with greater PICU (adjusted β coefficient, 6.35 [95% CI, 1.66‐11.0]; P = .009) and MV days (adjusted β coefficient, 5.22 [95% CI, 1.06‐9.38]; P = .015). Conclusion Among bronchiolitis patients admitted to the PICU, low WLZ at admission was associated with a longer duration of PICU stay and MV. Protein adequacy was associated with longer PICU and MV days in children with ≥48 hours of PICU stay.

A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

“…Despite widespread use of enteral and parenteral nutrition in critically ill children, caloric and protein underfeeding continue to remain a common problem, including amongst the viral bronchiolitis population [ 12 , 13 ]. Malnutrition and nutrition deterioration are associated with longer duration of mechanical ventilation, longer PICU and hospital length-of-stay, higher risk of hospital-acquired infections, and increased mortality [ 14 ].…”

Protein supplementation versus standard feeds in underweight critically ill children: a pilot dual-centre randomised controlled trial protocol

“…We will also compare total protein received by participants in the groups. We chose a separation of 0.5 g/kg/day protein as clinically meaningful based on our data from two cohorts of critically ill patients (bronchiolitis 27 and acute respiratory distress syndrome 9 ) which demonstrated that without supplementation, the median protein achieved within the first 3 days of illness was <1.0 g/kg/day and that 0.5 g/kg/day separation was associated with improved clinical outcomes, respectively. The number of participants who consented (or not) and completed (or discontinued early) the study and the reasons for non-consent/discontinuation will be summarised using counts and percentages.…”

Timing of enteral nutrition and parenteral nutrition in the PICU

“…A retrospective study of 107 children with acute respiratory distress syndrome demonstrated significantly reduced mortality with energy intake ≥80% of predicted resting energy expenditure using the Schofield equation 19 and minimum protein intake of 1.5 g/kg by day 3 compared with patients who did not achieve these targets 51 . Conversely, protein intake of ≥1.5 g/kg on PICU day 3 was associated with significantly prolonged duration of mechanical ventilation and PICU length of stay in a retrospective study of 74 infants and young children with critical illness secondary to bronchiolitis 52 . These small studies demonstrating opposing outcomes with reference to 1.5 g protein/kg intake lack sufficient power to determine differences between groups.…”

“…51 Conversely, protein intake of ≥1.5 g/kg on PICU day 3 was associated with significantly prolonged duration of mechanical ventilation and PICU length of stay in a retrospective study of 74 infants and young children with critical illness secondary to bronchiolitis. 52 These small studies demonstrating opposing outcomes with reference to 1.5 g protein/kg intake lack sufficient power to determine differences between groups. The retrospective study designs also increase the risk of multiple uncontrolled variables, including the possibility of overfeeding impacting outcomes.…”