236 Nutrition Support through Sedative Procedures: A Retrospective Comparison of Feeding Methods in Pediatric Burn Patients

Abstract

The hypermetabolic response to thermal trauma increases nutritional risk in pediatric burn patients. Interruption of feedings due to necessary clinical procedures leads to calorie and protein deficits, a constant challenge for the clinician. New methods for providing nutrition support that are safe and effective are needed. The objective of this study was to evaluate the nutritional and clinical outcomes associated with post pyloric enteral nutrition (EN) provided throughout sedation in pediatric burn patients as compared to a current standard of care of using parenteral nutrition (PN). A retrospective medical record review, grouping patients based on the type of nutrition support (EN or PN) received throughout sedative procedures was conducted. Sedative procedures included bedside dressing changes and operating room visits. Nutritional outcomes examined included: percent calorie goal achieved, percent protein goal achieved, and nil per os (NPO) hours. NPO hours refers to withholding any form of EN. Clinical outcomes included: intensive care unit (ICU) length of stay (LOS); total LOS; days on mechanical ventilation; days to wound closure; central venous catheter (CVC) days; hyperglycemic events; EN intolerance; and line infection. Statistical analysis was performed using repeated measures of ANOVA. Patients receiving PN had on average 13 more NPO hours than the EN group (p=.000), and a mean difference of 1 more hyperglycemic event (p=.03). There was an average of 1.6 more tube feeding intolerance events in the EN group, when compared to the PN group (p=0.01). There was no statistical significance between the EN and PN group in percent calories and protein goals achieved, wound closure days, LOS, ICU LOS, CVC days, or days on mechanical ventilation. Continued enteral nutrition support through sedation allowed patients to meet their goal calorie and protein requirements without adverse clinical outcomes. Parenteral nutrition can also be used safely in order to minimize nutritional deficits due to NPO time when unable to feed intraoperatively. This work describes an effective feeding method that can be used to avoid nutritional deficits in patients during sedative procedures.