Title

Early Enteral Nutrition Is Associated With Improved Clinical Outcomes in Critically Ill Children: A Secondary Analysis of Nutrition Support in the Heart and Lung Failure-Pediatric Insulin Titration Trial.

Authors

Vijay Srinivasan, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Natalie R Hasbani
Nilesh M Mehta
Sharon Y Irving, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Sarah B Kandil
H Christine Allen, Children's Hospital of Philadelphia, Philadelphia, PA
Katri V Typpo
Natalie Z Cvijanovich
E Vincent S Faustino
David Wypij
Michael S D Agus
Vinay M Nadkarni, Children's Hospital of Philadelphia, Philadelphia, PAFollow

Publication Title

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Document Type

Article

PubMed ID

31577692

Abstract

OBJECTIVES: The impact of early enteral nutrition on clinical outcomes in critically ill children has not been adequately described. We hypothesized that early enteral nutrition is associated with improved clinical outcomes in critically ill children.

DESIGN: Secondary analysis of the Heart and Lung Failure-Pediatric Insulin Titration randomized controlled trial.

SETTING: Thirty-five PICUs.

PATIENTS: Critically ill children with hyperglycemia requiring inotropic support and/or invasive mechanical ventilation who were enrolled for at least 48 hours with complete nutrition data.

INTERVENTIONS: Subjects received nutrition via guidelines that emphasized enteral nutrition and were classified into early enteral nutrition (enteral nutrition within 48 hr of study randomization) and no early enteral nutrition (enteral nutrition after 48 hr of study randomization, or no enteral nutrition at any time).

MEASUREMENTS AND MAIN RESULTS: Of 608 eligible subjects, 331 (54%) received early enteral nutrition. Both early enteral nutrition and no early enteral nutrition groups had similar daily caloric intake over the first 8 study days (median, 36 vs 36 kcal/kg/d; p = 0.93). After controlling for age, body mass index z scores, primary reason for ICU admission, severity of illness, and mean Vasopressor-Inotrope Score at the time of randomization, and adjusting for site, early enteral nutrition was associated with lower 90-day hospital mortality (8% vs 17%; p = 0.007), more ICU-free days (median, 20 vs 17 d; p = 0.02), more hospital-free days (median, 8 vs 0 d; p = 0.003), more ventilator-free days (median, 21 vs 19 d; p = 0.003), and less organ dysfunction (median maximum Pediatric Logistic Organ Dysfunction, 11 vs 12; p < 0.001).

CONCLUSIONS: In critically ill children with hyperglycemia requiring inotropic support and/or mechanical ventilation, early enteral nutrition was independently associated with better clinical outcomes.

Keywords

Adolescent, Child, Child, Preschool, Critical Illness, Enteral Nutrition, Female, Heart Failure, Hospital Mortality, Humans, Hyperglycemia, Infant, Infant, Newborn, Insulin, Intensive Care Units, Pediatric, Length of Stay, Male, Nutritional Support, Respiration, Artificial, Treatment Outcome

DOI

10.1097/PCC.0000000000002135

Publication Date

3-1-2020

Citation

Srinivasan, V., Hasbani, N., Mehta, N., Irving, S., Kandil, S., Allen, H., Typpo, K., Cvijanovich, N., Faustino, E., Wypij, D., Agus, M., & Nadkarni, V. (2020). Early Enteral Nutrition Is Associated With Improved Clinical Outcomes in Critically Ill Children: A Secondary Analysis of Nutrition Support in the Heart and Lung Failure-Pediatric Insulin Titration Trial.. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 21 (3), 213-221. https://doi.org/10.1097/PCC.0000000000002135