Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review

Abstract

Administration of enteral nutrition (EN) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) constitutes a major challenge due to the increased risk of complications, as well as the lack of well-trained healthcare professionals. EN is usually delivered via cyclic, continuous, or intermittent feeding; however, a number of potential barriers have been reported in the literature regarding different feeding regimens. The purpose of this review was to assess the effectiveness of continuous and intermittent bolus feeding on critically ill children. A systematic search was conducted in PubMed, Scopus Cochrane Central Register of Controlled Trials (CENTRAL) and a clinical trial registry up to September 2022, including randomized controlled trials (RCTs) published in the English language. Four studies met the inclusion criteria with a total population of 288 patients admitted to the PICU. Three studies were rated with a high risk of bias and one with some concerns. There was high heterogeneity between the studies in regard to the reporting of outcomes. Three studies measured the total time needed to reach prescribed caloric intake with conflicting results, while two studies evaluated the length of stay (LOS) in PICU with no difference between the two arms. One study assessed the time weaning from mechanical ventilation, favoring the bolus group. No data were provided for gastric residual volume (GRV), anthropometric measurements, and biochemical markers. Additional randomized trials with better methodology are needed to assess the efficacy of the two enteral feeding regimens in critically ill PICU patients.

Dietary factors and hypertension: A Mendelian randomization analysis

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Clinical effects and safety of semi-solid feeds in tube-fed patients: a meta-analysis and systematic review

“…Because the pH value in the stomach is not affected by eating, it can ensure effective blood perfusion of the gastrointestinal mucosa and prevent and cure intestinal bacterial translocation ( 47 ). However, some studies have found that intermittent feeding without infusion pump leads to a higher incidence of gastric tube dislocation, aspiration pneumonia, and abdominal distension than continuous infusion ( 48 , 49 ). Although there is no periodic fluctuation of gastrointestinal hormones during intermittent feeding, continuous enteral nutrition can maintain insulin, gastrin, and other gastrointestinal hormones at a high level, which is beneficial to intestinal absorption ( 50 ).…”

Substandard feeding in children undergoing mechanical ventilation in pediatric intensive care unit: A retrospective cohort study in China

“…Effective nutritional support is crucial for the prognosis of children in the intensive care unit (ICU). At present, enteral nutrition stands as the preferred choice for providing nutritional support to critically ill children (Theodoridis et al, 2023 ). Previous studies (Elke et al, 2016 ; Tian et al, 2018 ) have indicated that, in the absence of contraindications to enteral nutrition, early enteral nutrition for critically ill children is more suitable for the patient’s physiological status than parenteral nutrition.…”