Adrian Zurca, MD,
Associate Professor of Pediatrics
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania
Disclosure information not submitted.
Sebastian Gonzalez-Dambrauskas, MD
Attending Physician
LA Red Network, United States
Disclosure information not submitted.
Jose Colleti Junior, MD, PhD
Hospital Assunção Rede D'Or
São Paulo, Brazil
Disclosure information not submitted.
PABLO VASQUEZ-HOYOS, MD
Attending Physician
Universidad Nacional De Colombia, United States
Disclosure information not submitted.
Lee Jan Hau, MBBS, MRCPCH, MCI (he/him/his)
KK Women's and Children's Hospital, Singapore
Singapore, Slovenia
Disclosure information not submitted.
Donna Franklin, PhD
Researcher
Gold Coast University Hospital Children's Critical Care Research Group, United States
Disclosure information not submitted.
Steven Pon, MD, FCCM
Attending Physician
New York-Presbyterian Hospital/Weill Cornell Medical Center, United States
Disclosure information not submitted.
Todd Karsies, MD
Attending Physician
Nationwide Children's Hospital At Ohio State University, United States
Disclosure information not submitted.
Steven Shein, MD, FCCM
Rainbow Babies & Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Title: Variation in Fluid Management and Enteral Feeding for Infants with Critical Bronchiolitis
Introduction: Infants admitted to the pediatric intensive care unit (PICU) with critical bronchiolitis commonly require non-invasive and invasive respiratory support, which interrupts feeding and nutrition. PICU physicians’ usual fluid management and feeding practices for these patients are unknown.
Methods: A survey was developed to evaluate management of infants less than 12 months of age admitted to the PICU with bronchiolitis. IRB approval was obtained. The survey was distributed electronically to an international group of PICU providers in English, Spanish and Portuguese. Descriptive analyses were performed.
Results: 657 people responded to the survey, of which 79% were PICU attendings, 11% PICU fellows, and 4% advanced practice providers. Isotonic fluids are the most commonly prescribed for non-intubated (89%) or intubated (89%) patients, at a median rate of 100% of maintenance. For non-intubated patients, work of breathing is the most common variable affecting the timing of initiation of enteral feeding (93% of respondents), with 84% starting enteral feeds as soon as within 24 hours of PICU admission. Naso- or oro-gastric tube is the most common feeding route for infants on high flow nasal cannula (46%), followed by oral feeds (43%). Gastric feeds are more commonly preferred for infants requiring non-invasive support beyond high flow nasal cannula (65%). For intubated patients, hemodynamic status is the most common variable affecting the decision of when to initiate enteral feeding (82% of respondents), with 66% of respondents potentially starting enteral feeds within 24 hours of PICU admission. Gastric tubes are the most common feeding route for intubated infants (82%), followed by jejunal tube (17%). Diuretics are more commonly prescribed for intubated compared to non-intubated patients (41% vs. 13%; P < 0.001)
Conclusions: Naso- and orogastric tubes are the most commonly used routes for enteral feeding in infants with critical bronchiolitis, however, variation exists regarding feeding routes and timing of feeding initiation, especially when comparing non-invasive versus invasive respiratory support. Future studies for infants with critical bronchiolitis should focus on determining optimal fluid management strategies, as well as developing and implementing feeding protocols to optimize nutritional intake.