A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

Abstract

Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to two years old with critical bronchiolitis managed on continuous positive airway pressure, bilevel positive airway pressure, or RAM cannula were included. Of the 178 eligible patients, 64 were reportedly nil per os (NPO), while 114 received enteral nutrition (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of stay in the pediatric intensive care unit and non-invasive respiratory support were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 h and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring NRS.

Association between goal nutrition and intubation in patients with bronchiolitis on noninvasive ventilation: A retrospective cohort study

“…Previous studies have demonstrated a tendency to provide earlier EN to younger patients, but our study did not show that. 21 However, these groups were not identical. More of the patients in the goal-feed group started their PICU stay requiring NIPPV.…”

“…There are clear benefits of EN in the PICU. 12,21 Previous studies demonstrated that EN can be administered to patients on NIV, but safety has not been extensively studied. 17 We found that meeting goal feeds is associated with lower rates of intubation but longer hospital and PICU LOS and duration of NIV.…”

Challenges and advances in nutrition for the critically ill child

“…They found that enteral nutrition was initiated an average of 4 h after initiation of NIPPV and greater energy delivery was achieved when feeding via postpyloric tube compared with gastric tube, and in gastric-fed patients when feeds were continuous compared with intermittent [53]. Aspiration rates reported in these studies were low (<1.5%) [50,51,53]. These studies suggest that enteral nutrition may be feasible for some patients on NIPPV, but future studies should consider identifying selection criteria for the patient cohorts that will benefit the most from this strategy without increasing risk or harm to the patient secondary to delays in initiation or advancement of enteral nutrition and/or aspiration.…”

“…In children with bronchiolitis, enteral nutrition by nasoenteric tube, breastfeeding or per os, was initiated in 90% of patients within 48 h of admission in one study and within 24 h of admission in 71% in another study [50,51]. Enteral nutrition initiation in children with bronchiolitis requiring NIPPV was associated with improved heart rate and respiratory rate [50,52]. A multicenter European study examined enteral nutrition practices in critically ill children receiving NIPPV due to varied underlying causes for acute respiratory failure [53].…”

“…An increasing number of observational and retrospective studies have examined enteral nutrition delivery in critically ill children receiving NIPPV, including high-flow nasal canula. In children with bronchiolitis, enteral nutrition by nasoenteric tube, breastfeeding or per os, was initiated in 90% of patients within 48 h of admission in one study and within 24 h of admission in 71% in another study [50,51]. Enteral nutrition initiation in children with bronchiolitis requiring NIPPV was associated with improved heart rate and respiratory rate [50,52].…”