Feeding: the hidden variable affecting prognosis of critically ill children

Abstract

BackgroundNutrition of critically ill children is a frequently ignored issue. The purpose of this study was to describe nutritional practices in the pediatric intensive care unit (PICU) in a resource-limited country and evaluate their association with prognosis.MethodsThis was a prospective observational study, conducted on critically ill children admitted into PICU. Nutritional status was assessed, and nutritional practices (enteral and parenteral) were recorded. The primary outcome was PICU mortality.ResultsTwo hundred twenty-one patients were recruited. Mortality rate was 17.6%. Parenteral nutrition (PN) administration and longer PN duration were associated with mortality (p<0.001 for each). Early enteral nutrition was associated lower rates of mortality (5.6% vs 26.9%, p<0.001); hospital-acquired infections (18.9% vs 67.3%, p<0.001); and enteral feeding intolerance (13.3% vs 28.8%, p=0.018), compared with late enteral nutrition. Enteral nutrition onset correlated with length of PICU stay (rs=0.66, p<0.001); mechanical ventilation duration (rs=0.53, p<0.001); vasoactive infusion days (rs=0.25, p<0.001); central venous catheter days (rs=0.69, p<0.001); and time to full enteral caloric intake (rs=0.63, p<0.001). Bolus nasogastric feeding was superior to continuous nasogastric feeding since it was associated with a shorter time to full enteral caloric intake, without a higher risk of feeding intolerance or mortality. Malnutrition was associated with higher PN (75.4% vs 60.3%, p=0.03) and mortality (26.2% vs 14.1%, p=0.032) rates, in addition to longer mechanical ventilation duration (p=0.041) and time to full enteral caloric intake (p=0.010).ConclusionMalnutrition, PN, and late enteral nutrition are associated with poor outcome of PICU patients. Bolus nasogastric feeding appears to be superior to continuous feeding.