Eduardo Fastag Guttman, MD
Pediatric Critical Care Fellow
Loma Linda University Children's Hospital
Loma Linda, California
Disclosure information not submitted.
Jhoanne Cana, MD
Pediatrics Resident
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Salem Dehom, PhD
Assistant Professor
Loma Linda University School of Nursing, United States
Disclosure information not submitted.
Donald Moores, MD, FACS
Professor and Chief of Pediatric Surgery
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Cynthia Tinsley, BSN, MD, MSN, FCCM
Assistant Professor of Pediatrics
Loma Linda University, United States
Disclosure information not submitted.
Harsha Chandnani, MBA, MD, MPH
Assistant Professor of Pediatrics
Loma Linda University, United States
Disclosure information not submitted.
Title: Outcomes Associated with Early Enteral Nutrition in the Pediatric Trauma Patient
Introduction: International nutritional support guidelines express a consensus that enteral feeding should occur early in critically-ill patients who have an intact and functioning gastrointestinal (GI) tract. The goal of this study is to determine the effect of early (within 48 hours of admission) enteral nutrition on length of stay and number of ventilator days in the pediatric trauma population admitted to the intensive care unit.
Methods: This was a retrospective, single-center cohort study at a tertiary care children’s hospital, designated as a level one Pediatric Trauma Center. Patients were selected using the Institutional Pediatric Trauma Database and cross referencing patients with the institution’s Virtual Pediatric Systems, LLC database (VPS). Data was obtained for all children with a trauma diagnosis admitted to the PICU from January 1, 2014 to December 31, 2018. Patients were categorized as receiving early enteral nutrition if meeting 25% of their caloric needs by 48 hours, or late enteral nutrition if this was achieved at a later time.
Results: A total of 238 subjects were identified and included in our study and then classified as early enteral nutrition group (n=116) and late enteral nutrition group (n = 122). There was a significant difference on PICU LOS (IRR 1.25 95% CI 1.01-1.55, p = 0.039) and hospital LOS (IRR 1.33 95% CI 1.07-1.66, p = 0.011), with no significant difference in number of days on mechanical ventilation (IRR 1.21 95% CI 0.86-1.7, p = 0.28). Initiation of early enteral nutrition, when compared with late initiation of enteral nutrition, was associated with lower intubation rates (44.8% vs. 73%, p < 0.001), lower opioid total daily dose (0.4 MME/Kg/day vs. 0.6 MME/Kg/day, p < 0.001), earlier goal feeds achievement (2 days vs. 5 days, p < 0.001), and less use of vasoactive medications (9.5% vs. 23%, p = 0.005).
Conclusions: Initiation of early enteral nutrition within 48 hours of admission to PICU is associated with decreased PICU and hospital lengths of stay with no significant effect on mechanical ventilation days after controlling for Injury Severity Score, Pediatric Index of Mortality Score, Pediatric Risk of Mortality-III score as well as opioid total daily dose, use of vasoactives, number of regions injured and number of surgical procedures performed.