The Use of High-Flow Nasal Cannula and the Timing of Safe Feeding in Children with Bronchiolitis

Abstract

The use of high-flow nasal cannula (HFNC) as non-invasive respiratory support in children with bronchiolitis has increased over the last several years. Several studies have investigated enteral feeding safety while on HFNC. This study compares the safety of oral feeding prior to and following implementation of an HFNC feeding guideline. Patients and methodsA retrospective study was designed, in children ≤2 years of age with bronchiolitis, requiring HFNC, from 2017 to 2019. We defined feeding complications on HFNC and defined safety as the absence of such complications. We gathered the following data: oral feeding timing from the HFNC initiation, duration of enteral feeding on HFNC, and HFNC flow rate at which the feeding was initiated. We compare the data prior to and post-implementation of an HFNC feeding guideline. ResultsDescriptive statistics were calculated separately by pre and post guideline implementation. Patients in both pre and post guideline implementation groups had no feeding complications on HFNC. Subjects in the post (n=50) vs. pre-guideline implementation (n=36) had a higher median amount of liters flow when initiating enteral feeding (8.0 vs. 6.0 respectively, p<0.024), spent fewer days in the pediatric intensive care unit (PICU) (two days vs. 0 days). Post guideline implementation, enteral feeding was initiated sooner (days nil per os [NPO] 1.0 vs 2.0). No other significant differences between the two cohorts with respect to other variables were observed. ConclusionsOur data supports that oral feeding in patients with bronchiolitis on HFNC is safe. Utilization of current guidelines allowed safe earlier feeding of children on HFNC, reducing the time spent NPO.

Impact of different nebulisation systems on patient comfort in bronchiolitis: a randomised controlled cross-over trial

“…Caregivers of children hospitalised for severe bronchiolitis exhibit remarkably high levels of anxiety during their child’s hospitalisation, and the feeding process is one cause of this stress 19. Moreover, oral feeding is generally recommended as a first-line nutritional strategy, especially in cases of bronchiolitis in breastfeeding infants, and the infants with bronchiolitis being treated with HFNC can be safely fed via enteral route 20 21. In this study, the feeding factor, in addition to the reduced analgesic requirements, might have played key roles in the improved comfort and satisfaction perceived with the NHF system.…”

Feeding Pathway for Children on High Flow Nasal Cannula Decreases Time to Enteral Nutrition

“… 21 However, Conway et al added feeding initiation parameters to their hospital bronchiolitis pathway and reported a one-day NPO period post guideline initiation. 23 Since our time to feed initiation was between that reported by these prior studies without an increase in adverse events, we may consider amending our pathway to have a more rapid EN up-titration.…”

“…This is lower than aspiration events reported by Slain et al (5.8%, 70 patients), 15 comparable to the aspiration risk in the European (325 patients) and Shadman studies (78 patients), 21 - 22 and slightly higher than Conway et al (86 patients). 23 The one patient in our cohort who required escalation of respiratory support post EN initiation was a three-year-old admitted for status asthmaticus with worsening bronchospasm while asleep requiring BiPAP. Since only nocturnal BiPAP was required, it is hard to associate this escalation with EN alone.…”

“… 15 , 21 – 23 The literature also reports patients fed while receiving HFNC had decreased PICU LOS, earlier oral feeding, and received higher liter/min flow without increased adverse events. 22 , 23 …”

High Flow Nasal Cannula Oxygen Therapy in Pediatric Patients

“…They also determined that the length of stay in the pediatric intensive care unit decreased in those to whom the guideline was applied. Using existing guidelines reduced the time spent in NPO (Nil'Per Os) by ensuring earlier feeding of children during follow-up with HFNC (Conway et al, 2021).…”