Stephen Gorga, MD, MSc
Assistant Professor of Pediatrics
CS Mott Childrens Hospital at University of Michigan, United States
Disclosure information not submitted.
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Title: NPO Status in the Pediatric Intensive Care Unit
Introduction: Adequate enteral nutrition is crucial to healing in critically ill children but feeding interruptions are frequent in the pediatric intensive care unit (PICU). Institutional nil per os (NPO) guidelines require that children fast for ≥6 hours for solids and only ≥2 hours for clear liquids prior to anesthesia events. Without a recommended maximum duration, patients are often placed NPO at midnight prior to a planned anesthesia event, decreasing nutrition and increasing IV fluid exposure. This study aims to describe current NPO duration and IV fluid exposure in a tertiary PICU.
Methods: This retrospective cohort of children ≤21 years old admitted to a tertiary PICU from January 2015-December 2020 who underwent a procedure or planned imaging study with an NPO order placed after admission and were tolerating enteral nutrition in the 24 hours prior to NPO start. Patients were excluded if they were already NPO prior to planned procedure or imaging study or if they required specific IV fluid composition. Our primary outcome was the median duration of NPO time in hours.
Results: A total of 189 patients met inclusion criteria. The median duration of NPO status was 13.3 [8.0-23.0] hours. Most (99/189, 52.4%) were male, 140/189 (74.1%) were Caucasian, and had a median age of 120 [interquartile range (IQR) 60-180] months and an ICU admission length of 6 [3-14] days. Thirty-five patients (18.5%) were endotracheally intubated prior to NPO status. Anesthesia events requiring NPO status included radiologic studies (32.8%), neurosurgery (19.6%) and general surgery (13.8%). Patients had a median weight adjusted fluid exposure during NPO time of 34 [17.2-57.9] ml/kg.
Conclusions: This study shows that NPO duration in children previously tolerating enteral nutrition in the PICU exceeds the recommended minimum duration in non-emergent cases requiring anesthesia. An opportunity exists to evaluate barriers and facilitators to enhance active decision making surrounding NPO status for PICU patients undergoing planned anesthesia events to maximize nutrition and minimize harm.