A review of feeding intolerance in critically ill children

Tume, Lyvonne N; Valla, Frédéric V.

doi:10.1007/s00431-018-3229-4

Cited by 44 publications

(50 citation statements)

References 47 publications

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“…Since this study was completed, additional evidence has been published that supports our findings that suggest using GRV and/or abdominal girth are not predictors of emesis and are of limited, if any, value as intolerance criteria and suggest that spontaneous emesis may be the single best indicator of feeding intolerance. 14,15,17,18 Rather, routine measurement of GRV and abdominal girth may have contributed to an unnecessary cessation of EN and its essential benefits. Continued study in the PICU population is needed to validate findings in the adult critical care literature in this varied population and to identify an evidence-based protocol for the appropriate management of intolerance events.…”

Section: Figurementioning

confidence: 99%

Bolus vs Continuous Nasogastric Feeds in Mechanically Ventilated Pediatric Patients: A Pilot Study

Brown

Forbes

2018

J Parenter Enteral Nutr

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Background Malnutrition increases the risk of mortality and morbidity in the pediatric intensive care unit (PICU). Barriers to adequate delivery of enteral nutrition (EN) include hemodynamic instability, feeding interruptions and intolerance, and lack of standardized feeding protocols. The most recent guidelines on nutrition support for the critically ill child describe a paucity of evidence around the best method to deliver EN. There is an untested clinical assumption that bolus gastric feeding (B‐GF) in intubated patients is associated with aspiration events, lung injury, and associated morbidity compared with continuous gastric feeding (C‐GF). This study compared the effectiveness and safety of C‐GF vs B‐GF in intubated pediatric patients. Methods We enrolled randomized patients aged 1 month–12 years who were intubated within 24 hours and received EN starting within 48 hours of admission to a C‐GF or B‐GF group. Goal‐directed EN volume and caloric density were increased every 3 and 12 hours, respectively, to target. Feeding interruptions and intolerance events were recorded. Results Twenty‐five subjects were enrolled (B‐GF = 11; C‐GF = 14). At 24 hours, B‐GF was associated with higher energy and protein delivery (P < 0.007) and was associated with faster time to goal volume (median B‐GF = 15 hours; C‐GF = 29.5 hours). No aspiration events resulting in additional lung injury were noted for either group (P = 0.866). Conclusions B‐GF was associated with superior delivery of EN with a comparable safety profile to C‐GF. Further study is needed to compare both EN methods in other PICU populations.

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Section: Figurementioning

confidence: 99%

Bolus vs Continuous Nasogastric Feeds in Mechanically Ventilated Pediatric Patients: A Pilot Study

Brown

Forbes

2018

J Parenter Enteral Nutr

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“…Inadequate intake and gastrointestinal symptoms are the most commonly used descriptors to describe feeding intolerance (42)(43)(44) . Despite the lack of evidence to support the use of GRV as a surrogate for delayed gastric emptying (26,44,45) , large GRV has been used as the most common reason for feeding interruptions (6,40,46) Both centres in the present study had similar criteria GRV as a surrogate marker of gastric emptying. GRV was measured in 88%-100% of infants, with mean (SD) GRV low measured volumes [3.5 (5.4) to 4.7 (5.6) mL kg À1 day À1 ].…”

Section: Discussionmentioning

confidence: 82%

“…Gastric fed infants had a mean (SD) GRV of 3.5 (2.9) mL kg À1 day À1 and post-pyloric fed infants a GRV of 5.4 (6.9) mL kg À1 day À1 . Feeding was withheld for perceived feeding intolerance in two infants (7%) on two occasions for 19.5 h. In PICU-2, medication for the management of diarrhoea was prescribed to four infants (14%) on a median (IQR) of 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) occasions.…”

Section: Gastrointestinal Symptomsmentioning

confidence: 99%

Peptide nutrient‐energy dense enteral feeding in critically ill infants: an observational study

Marino

Eveleens

Morton

et al. 2019

J Human Nutrition Diet

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Background Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient‐energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs). Methods Records from critically ill infants aged <12 months admitted to two PICUs were retrospectively reviewed with a PICU length of stay (LOS) ≥ 7 days. Achievement of nutritional targets for the duration of PEF was reviewed. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. Results In total, 53 infants were included, with a median age on admission of 2.6 months. Median admission weight was 3.9 kg in PICU‐1 and 4.7 kg in PICU‐2. Median (interquatile range) energy intake in PICU‐1 and PICU‐2 was 68 (47–92) and 90 (63–124) kcal kg−1, respectively, and median (interquatile range) protein intake 1.7 (1.1–2.4) g kg−1 and 2.5 (1.6–3.2) g kg−1, respectively. Feeding was withheld because of feeding intolerance in one infant (4%) on two occasions in PICU‐1 for 2.5 h and in two infants (7%) on two occasions in PICU‐2 for 19.5 h. Gastric residual mean (SD) volumes were 3.5 (5.4) mL kg−1 in PICU‐1 and 16.9 (15.6) mL kg−1 in PICU‐2. Conclusions Peptide nutrient‐energy dense feeding in infants admitted to the PICU is feasible, well tolerated and nutritional targets are met. However, with this study design, it is not possible to draw any conclusions regarding the benefit of PEF over standard PE feed in critically ill children and future work is required to clarify this further.

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“…Therefore, it is imperative to take measures to reduce rate of NEC. Feeding with maternal milk (MM) may be one of the best measures to reduce the rate of NEC, because many studies have found that, compared with pure formula feeding (PF), MM feeding reduces the rate of NEC [4][5][6][7] and feeding intolerance (FI) [8]. This effect may be due to several nutritional and immune components that promote a healthy intestinal mucosa barrier function and dampen the hyper inflammatory responses to pathologic bacteria.…”

Section: Introductionmentioning

confidence: 99%

“…Newkirk M, Shakeel F, Parimi P, Rothpletz-Puglia P, Patusco R, Marcus AF, et al 1 PS, pulmonary surfactant; 2 HMF, Human milk fortifier; 3 NEC, Necrotizing enterocolitis; 4 FI, feeding intolerance; 5 LOS, Late onset sepsis; 6 ROP, retinopathy of prematurity; 7 IVH, Intraventricular hemorrhage; 8 BPD, Bronchopulmonary dysplasia. Note: Continuous data expressed as mean (standard deviation) or median (interquartile range), and categorical data as n (%).…”

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confidence: 99%

Dose relationship between maternal milk proportion and necrotizing enterocolitis development

Lin¹,

Sun²,

Xiong³

et al. 2019

Preprint

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Background: To examine the dose effect of maternal milk (MM) feeding on neonatal necrotizing enterocolitis (NEC) development. Methods: This retrospective study included 305 infants [birth weight<1 500 g, or gestation age (GA)<32 weeks]. Curve estimation was performed to evaluate the dose relationship between MM proportion and NEC. Then infants were grouped based on curve trend and multivariable regression analysis was conducted to prove the curve estimation.Results: Rate of NEC for the sample was 7.9% and age at onset was 25.6(16.0–26.0) days. The curve showed that when MM proportion was increased from zero to 20%, rate of NEC increased from 25% to 40% at first and when MM from 20% to 100%, rate dropped from 40% to near zero. In the MM proportion from zero to 40%, rate of NEC changed greatly. The multiple regression analysis showed that compared with MM proportion >0.70, 0.4<MM proportion £0.7 was associated with a 5.482- fold higher odds of developing NEC（P=0.032）; 0<MM proportion £0.4 was a 24.99-fold increase in the odds of developing NEC（P<0.001）; MM proportion =0 was a 9.348-fold increase in the odds of developing NEC（P=0.003）. Conclusion: This study estimated how rate of NEC changed with MM proportion increase, MM proportion being greater than 40% had a significant protection against NEC. We should encourage mother for breast milk and alert to NEC when the preterm is mixed feeding with MM proportion less than 40%.

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A review of feeding intolerance in critically ill children

Cited by 44 publications

References 47 publications

Bolus vs Continuous Nasogastric Feeds in Mechanically Ventilated Pediatric Patients: A Pilot Study

Bolus vs Continuous Nasogastric Feeds in Mechanically Ventilated Pediatric Patients: A Pilot Study

Peptide nutrient‐energy dense enteral feeding in critically ill infants: an observational study

Dose relationship between maternal milk proportion and necrotizing enterocolitis development

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