Oral Nutrition in Children With Bronchiolitis on High-Flow Nasal Cannula Is Well Tolerated.

Abstract

To determine the incidence of aspiration-related respiratory failure and nutrition interruptions in children with bronchiolitis on high-flow nasal cannula (HFNC) receiving enteral nutrition. We performed a single-center, prospective, observational cohort study within a 313-bed tertiary medical center from January through December 2015. We included term children 1 month to 2 years of age without comorbid bacterial pneumonia or chronic medical conditions who were diagnosed with bronchiolitis while receiving HFNC and enteral nutrition. Primary outcomes were incidence of aspiration-related respiratory failure and nutrition interruptions. Secondary outcomes were duration of HFNC therapy, length of stay, and nutrition characteristics. Of the 344 children admitted with bronchiolitis, 132 met the inclusion criteria. Ninety-seven percent received enteral nutrition by mouth and 3% by nasogastric tube. HFNC flow rates at the time of nutrition initiation ranged between 4 and 13 L per minute (0.3-1.9 L/kg per minute) and respiratory rates from 18 to 69 breaths per minute. One (0.8%) subject had aspiration-related respiratory failure and 12 (9.1%) experienced nutrition interruptions. Children with interruptions in nutrition had a longer length of stay by 2.5 days (P < .01) and received an additional day of HFNC therapy (P < .01). By discharge, 55 (42%) children achieved all nutritional goals: caloric, volume, and protein. Children admitted overnight had an increased incidence of delay to nutrition initiation (30% vs 11%; P < .01). We observed a low incidence of aspiration-related respiratory failure in term children with bronchiolitis on HFNC receiving enteral nutrition. Oral nutrition was tolerated across a range of HFNC flow and respiratory rates, suggesting the practice of withholding nutrition in this population is unsupported.