Enid Martinez, MD
Boston Children's Hospital
West Roxbury, Massachusetts
Disclosure information not submitted.
Patrice Melvin, MPH
Biostatistician IV
Boston Children's Hospital, United States
Disclosure information not submitted.
Charles Callif, BA
Research Assistant
Boston Children's Hospital, United States
Disclosure information not submitted.
Ashley Turner, MD
Fellow in Pediatric Critical Care Medicine
Boston Childrens Hospital, United States
Disclosure information not submitted.
Susan Hamilton, MS, , RN, CCRN
Pediatric Nurse Practice Specialist in Wound/Ostomy/Continence Care
Boston Children's Hospital
Boston, Massachusetts
Disclosure information not submitted.
Nilesh Mehta, MD
Senior Associate in Critical Care Medicine
Boston Children's Hospital, United States
Disclosure information not submitted.
Title: Post-pyloric versus gastric feeding in critically ill children- a propensity-score matched analysis
Introduction: Optimal enteral nutrition (EN) strategy is associated with improved clinical outcomes in critically ill children. In patients with intolerance to gastric (G) EN, the post-pyloric (PP) route is utilized. We hypothesized that PPEN is associated with greater nutrient delivery compared to GEN in critically ill children.
Methods: We performed a 1:1 propensity-score matched (PSM) analysis including children (age < 21 years) admitted to a single-center, multidisciplinary intensive care unit (ICU) for >48 hours who received G or PP EN. Data were extracted using the Pediatric Health Information System (PHIS) database and institutional electronic medical record. We matched 51 PPEN patients to 51 GEN patients for demographics, admission diagnosis, mode of ventilation, medications, and PIM2 score. Primary outcome was energy delivery [(kcal/kg/day delivered ÷ kcal/kg/day prescribed)*100] on days 1-3 of EN provision. Secondary outcomes were time to EN initiation after admission, hours (H) of EN interruptions, ICU length of stay (LOS), days of mechanical ventilation (MV), and mortality. We used logistic regression models and generalized linear mixed effects models, significance was set at p< 0.05
Results: There were no significant differences in demographics or clinical variables between the PP and G EN groups by the PSM. Average (SD) age was 4.8 years (6.2) for GEN and 6.8 years (7.1) for PPEN. 63% of GEN and 71% of PPEN patients were male. Median (IQR) time to EN initiation was not different- GEN 3.55 days (1.5, 6.5) and PPEN 3.25 days (2, 6.8), p=0.39. EN energy delivery was greater in PPEN than GEN group on Days 1-3 of EN delivery: PP 60%, 51%, 74.5% and G 21%, 22%, 17%, p< 0.05. Time to achieving 66% of EN goal was 2 days for PPEN versus 7 days for GEN, HR 1.89, 95% CI 1.09 to 3.26, p=0.023. Hours of EN interruptions were greater for G than PP EN on Day 1 of EN delivery (G 15H (9) and PP 7.2H (6), p=0.004), but similar on Days 2 and 3. Average ICU LOS, MV days and mortality were not different between the groups.
Conclusions: Earlier and greater EN delivery was achieved in critically ill children fed via the PP compared to the G route. There were no differences in clinical outcomes between the two routes. Future studies should explore the role of PPEN and its effect on nutritional status and functional outcomes.