Constipation in the Critically Ill Child: Frequency and Related Factors

López, Jorge; Botrán, Marta; García, Arístides Rivas; González, Rafael; Solana, María José; Urbano, Javier; Fernández, Sarah N.; Sánchez, César Sánchez; López‐Herce, Jesús

doi:10.1016/j.jpeds.2015.06.046

Cited by 24 publications

(35 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, gastric aspiration might be useful for detecting tube dislocation when gastric retention does not solely consist of gastric secretion . The prevalence of constipation was 7%, which is much lower than previously reported in a study of critically ill children (prevalence of 46.7%) . Of note, we did find a large number of infants (62%) who vomited at least once when on PE‐formula.…”

Section: Discussioncontrasting

confidence: 66%

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

Eveleens

Dungen

Verbruggen

et al. 2018

J Human Nutrition Diet

View full text Add to dashboard Cite

Background: Reaching an optimal nutritional intake is challenging in critically ill infants. One possible way to minimise nutritional deficits is the use of protein and energy-enriched (PE)-formulas. We aimed to describe weight achievement and gastrointestinal symptoms in infants admitted to the paediatric intensive care unit (PICU) while receiving PE-formula for a prolonged period. Methods: Records from infants admitted to a multidisciplinary PICU and using PE-formula were analysed retrospectively. Infants were eligible if they received PE-formula daily for at least 2 weeks. Weight achievement was determined as the difference between weight-for-age (WFA) Z-scores at the start and end of PE-formula use. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. Results: Seventy infants with a median [interquartile range (IQR)] age of 76 (30-182) days were eligible. The PICU duration was 50 (35-83) days during which they received PE-formula for 30 (21-54) days. Predominant admission diagnoses were post-cardiac surgery, respiratory and cardiac diagnosis. A significant mean (SD) WFA Z-score increase of 0.48 (1.10) (P < 0.001) and a median (IQR) weight gain of 5.80 (3.28-9.04) g kg À1 day À1 was observed. Multivariate regression showed that a lower WFA Z-score at start was associated with a higher WFA Z-score increase during PE-formula use (b À0.35 (95% confidence interval = À0.50 to À0.19); P < 0.001). The maximum 24-h gastric residual volume was 8.1 mL (IQR = 2.2-14.3) for each 1 kg in bodyweight. Three (4%) infants were treated for diarrhoea and three infants were treated for vomiting. Conclusions: The majority of infants with a prolonged PICU stay showed weight improvement when using PE-formula. PE-formula was well tolerated because gastrointestinal symptoms only occurred in few infants.14% to 32% of critically ill infants already suffer from acute or chronic malnourishment upon admission to the PICU (1,2) . Development of malnutrition during PICU stay is associated with increased mortality, length of mechanical ventilation and length of stay (3,4) . Infants are 3

show abstract

Section: Discussioncontrasting

confidence: 66%

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

Eveleens

Dungen

Verbruggen

et al. 2018

J Human Nutrition Diet

View full text Add to dashboard Cite

show abstract

“…Surprisingly, constipation, which is frequent in critically ill children, is less commonly considered as a sign of feeding intolerance in PICU. A study of 150 children [17] found constipation occurred in 47% of children who spent more than 3 days in the PICU. A number of factors influenced the development of constipation (defined as 3 days without a bowel movement) including immobility, opiates and other commonly used PICU drugs, delayed enteral feed administration, splanchnic hypoperfusion, inflammation, sepsis, and electrolyte disturbances (most notably hypercalcemia, hypokalemia, hypomagnesemia, and hypophosphatemia).…”

Section: Bowel Sounds and The Frequency Of Bowel Movementsmentioning

confidence: 99%

“…A number of factors influenced the development of constipation (defined as 3 days without a bowel movement) including immobility, opiates and other commonly used PICU drugs, delayed enteral feed administration, splanchnic hypoperfusion, inflammation, sepsis, and electrolyte disturbances (most notably hypercalcemia, hypokalemia, hypomagnesemia, and hypophosphatemia). They found a significantly higher incidence in surgical patients and in older higher weight children, in addition to those who received little enteral nutrition which was started later [17]. Diarrhea (still inadequately defined in neonates and small infants) can also occur in critically ill children, although the reported incidence is lower than that reported in critically ill adults of 15-38% [36,47].…”

Section: Bowel Sounds and The Frequency Of Bowel Movementsmentioning

confidence: 99%

A review of feeding intolerance in critically ill children

Tume

Valla

2018

Eur J Pediatr

View full text Add to dashboard Cite

Ensuring optimal nutrition is vital in critically ill children and enteral feeding is the main route of delivery in intensive care. Feeding intolerance is the most commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition, yet the definition for this remains inconsistent, nebulous, and entirely arbitrary. Not only does this pose problems clinically, but research in this field frequently uses feeding intolerance as an endpoint and the heterogeneity in this definition makes the comparison of studies difficult and meta-analysis impossible. We reviewed the use of, and definitions of, the term feed intolerance in pediatric intensive care research papers in the last 20 years. Gastric residual volume remains the most common factor used to define feed intolerance, despite the lack of evidence for this. Healthcare professionals would benefit from further education to improve their awareness of the limitations of the markers to define feeding intolerance, and the international PICU community needs to agree a consistent definition of this phenomenon to improve consistency in both practice and research.Conclusion: This paper will provide a narrative review of the definitions of, evidence for, and markers of feeding intolerance in critically ill children.

show abstract

“…In this sample, 15.2% of patients before and 13.6% of patients after the implementation remained on the ICU. As shown by Lopez and colleagues () in their study on one ICU, the prevalence of constipation was very high. It was for this reason that we suggest a similar education program for the ICU nurses in order to decrease the constipation rate.…”

Section: Discussionmentioning

confidence: 70%

Constipation prophylaxis in children undergoing orthopedic surgery: A quasi‐experimental study

Mantegazzi

Seliner

Imhof

2016

Specialist Pediatric Nursing

View full text Add to dashboard Cite

show abstract

Constipation in the Critically Ill Child: Frequency and Related Factors

Abstract: Constipation is common in critically ill children. Body weight, Pediatric Index of Mortality 2 clinical severity score, admission after surgery, and the need for vasoconstrictor therapy are major independent risk factors associated with constipation.

Cited by 24 publications

References 25 publications

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

A review of feeding intolerance in critically ill children

Constipation prophylaxis in children undergoing orthopedic surgery: A quasi‐experimental study

Contact Info

Product

Resources

About