Which is the best route to achieve nutritional goals in pediatric ECMO patients?

Hofheinz, Sylvia Belda; Núñez-Ramos, Raquel; Germán-Díaz, Marta; Melgares, Lidia Oviedo; Arroba, Cristina Martín-Arriscado; López-Fernández, Eduardo; Moreno-Villares, José Manuel

doi:10.1016/j.nut.2021.111497

Cited by 5 publications

(22 citation statements)

References 15 publications

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“…No randomized clinical trials were identified in this literature search. Studies did not always specify where the samples were obtained, but seven studies specified the PICU (2, 8, 13, 18, 19, 21, 22). Five studies were conducted in The Netherlands (12, 17, 19, 20, 24), four studies in the United States (9, 13, 18, 23), two studies in Spain (2, 21), one study in Singapore (8), one study in China (25), and one study in Thailand (22).…”

Section: Methodsmentioning

confidence: 99%

“…In the five studies that listed sex, both males and females were represented evenly (8, 9, 13, 17, 23, 24). Neonatal pulmonary and cardiac diseases were the greatest underlying diagnoses requiring ECMO (2, 8, 9, 12, 17–25). Four studies evaluated patients who only received EN (9, 12, 13, 20).…”

Section: Methodsmentioning

confidence: 99%

“…Four studies evaluated patients who only received EN (9, 12, 13, 20). Ten studies evaluated groups of patients who received EN along with those who received a combination of EN and PN (2, 8, 17–17, 21–25).…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, Wertheim et al (24) and Ohman et al (23) found that EN was the preferred route of nutrition for neonatal and pediatric patients on ECMO compared with PN. Hofheinz et al (21) found that receiving PN was independently associated with higher infection rates than those receiving EN. Ong et al (8) also noted that EN was not associated with the higher rates of infection associated with ECMO.…”

Section: Methodsmentioning

confidence: 99%

“…Many studies did not report the rate of those who reached full EN (2, 8, 9, 12, 13, 17, 22, 25). In the studies that presented adequate caloric goals, an average of 22% of patients achieved the caloric goals over a 1- to 5-day period (18–21, 23, 24). No studies used indirect calorimetry to assess calorie goals but instead used predictive equations due to the challenges of multiple gas exchange sites during ECMO therapy (2, 8).…”

Section: Methodsmentioning

confidence: 99%

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Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

Dennis

Jordan

Rice

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: The number of infants and children requiring extracorporeal membrane oxygenation (ECMO) is rising. While critically ill, providers may believe that enteral nutrition puts the patient at risk for severe complications such as necrotizing enterocolitis. However, enteral nutrition is associated with the potential to improve the gut barrier and reduce the risk of morbidity and mortality. The purpose of this article is to review the existing evidence about providing exclusive enteral and parenteral nutrition and its association with rates of complications and mortality in critically ill neonatal and pediatric populations on ECMO. DATA SOURCES: Literature addressing enteral nutrition while on ECMO for neonatal and pediatric populations was searched using PubMed, CINAHL, and Scopus. STUDY SELECTION: Studies ranged from 1998 to 2022 and were conducted mostly in the PICU and neonatal ICU settings. DATA EXTRACTION: Fourteen articles were reviewed after inclusion and exclusion criteria were applied. DATA SYNTHESIS: Characteristics included an even number of males and females in samples from mostly PICUs. The predominant underlying illnesses were neonatal pulmonary disease and cardiac disease. Upon reviewing the literature, three major themes were revealed: no significant complications with enteral feeding, underutilization of enteral feeding, and reduced mortality with enteral feeding. CONCLUSION: The use of enteral nutrition in the neonatal and pediatric population while on ECMO has the potential to improve survival rates and reduce complications. Further studies are needed to investigate how to optimize this population’s nutrition and develop feeding protocols and pathways.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

Dennis

Jordan

Rice

et al. 2023

Pediatric Critical Care Medicine

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Enteral nutrition in children and adolescents who receive extracorporeal membrane oxygenation and its impact on complications and mortality: A systematic review and meta‐analysis

Li,

Fan,

Pan

et al. 2024

J Parenter Enteral Nutr

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Enteral nutrition (EN) is one method of nutrition support for children and adolescents receiving extracorporeal membrane oxygenation (ECMO) therapy, and there are no guidelines for its use in this population. We conducted a systematic review to determine whether EN is effective and safe in children supported by ECMO. We searched the Cochrane Library database, MEDLINE, and Embase on Ovid in March 2023 to identify studies that evaluated children and adolescents who received ECMO and were treated with EN. Random effects meta‐analysis was used to estimate the odds of mortality with EN compared with parenteral nutrition (PN). A total of 14 studies were included in this review with 1650 patients (796 received EN). The median duration of ECMO was 5–10 days, and the median EN initiation time ranged from 23 h to 7 days. The pooled results suggest no significant difference in mortality with EN compared with PN (odds ratio [OR] = 0.77; 95% CI, 0.56–1.05; I2 = 26%). Exclusion of the only study that reported an increase in mortality resulted in a borderline significant reduction in mortality with EN (OR = 0.71; 95% CI, 0.51–1.00; I2 = 26%). The predictors of EN were male sex, older age, heavier weight, greater height, cardiac diagnosis, longer duration of ECMO, and use of venovenous ECMO. Most studies suggest no correlation between EN and complications. EN use in children and adolescents who receive ECMO does not appear to be associated with increased mortality compared with PN and was safe in terms of intestinal complications and feeding intolerance.

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Challenges of Nutrition Support in Pediatric Patients Requiring Extracorporeal Membrane Oxygenation

Zivick,

Kilgallon,

Cheifetz

2023

ASAIO Journal

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Nutrition support in critically ill infants and children remains an integral part of providing optimal care for these patients. The pediatric patient requiring extracorporeal membrane oxygenation therapy faces specific challenges to the provision of suitable nutrition support. In this review, we aimed to summarize the existing literature around some of the more challenging aspects of delivering appropriate nutrition to children receiving extracorporeal membrane oxygenation.

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Which is the best route to achieve nutritional goals in pediatric ECMO patients?

Cited by 5 publications

References 15 publications

Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

Enteral nutrition in children and adolescents who receive extracorporeal membrane oxygenation and its impact on complications and mortality: A systematic review and meta‐analysis

Challenges of Nutrition Support in Pediatric Patients Requiring Extracorporeal Membrane Oxygenation

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