Underweight Status Is an Independent Predictor of In‐Hospital Mortality in Pediatric Patients on Extracorporeal Membrane Oxygenation

Antón-Martín, Pilar; Papacostas, Michael F.; Lee, Elisabeth; Nakonezny, Paul A.; Green, Michael L.

doi:10.1177/0148607116673185

Cited by 30 publications

(44 citation statements)

References 36 publications

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“…Although undernutrition in critically ill children, and more specifically in children requiring ECMO support, has been associated with a poor prognosis ( 6 – 8 ), in our study, undernutrition was not associated with higher mortality or more gastrointestinal problems. Only children who needed prolonged ECMO support had more complications as reflected in the multivariable study.…”

Section: Discussioncontrasting

confidence: 72%

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Pérez

Gonzalez

Zamora

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives: To assess the safety of enteral nutrition (EN) in children on extracorporeal membrane oxygenation (ECMO). To describe nutritional status and the characteristics of the nutritional support in this population. Methods: A retrospective single-center analysis (2006–2016) including children <18 years on ECMO. Demographic data, nutritional status, characteristics of nutritional support, and development of gastrointestinal (GI) complications were recorded. Results: One hundred children, with a median age of 9.7 months (interquartile range [IQR] 3.9–63.1) were enrolled. Undernutrition was prevalent among children on ECMO (33.3%) mainly in patients <2 years ( P = 0.042). Most patients (64%) received EN at some point during ECMO therapy. EN was administered in the first 48 hours after ECMO initiation (48HEN) to 60.3% of the children. Mortality rate in the Pediatric Intensive Care Unit was lower in patients who received EN as the initial artificial nutrition support (ANS) (37.7 vs 51%, P = 0.005) and in children on 48HEN (34% vs 50%, P = 0.04). In the logistic regression analysis, duration of ECMO support and low cardiac output indication were the only factors associated with mortality. Although most patients on ECMO (45%) developed digestive complications, they were mostly mild, being constipation the most prevalent. In the logistic regression analysis, EN was not associated with an increase in GI complications ( P = 0.09). Only three patients developed intestinal ischemia (one without EN and two on EN). Conclusions: Undernutrition is prevalent among children on ECMO, mainly in infants <2 years. EN is not associated with severe gastrointestinal complications or higher mortality in these children.

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Section: Discussioncontrasting

confidence: 72%

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Pérez

Gonzalez

Zamora

et al. 2021

J. pediatr. gastroenterol. nutr.

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“…Anton‐Martin et al, showed in a retrospective single center review of 20 years and 491 pediatric ECMO patients, that 24% of their patients were underweight which was independently associated with increased mortality with an odds ratio (OR) of 2 . In a retrospective review of the PHIS database, the use of inhaled nitric oxide (iNO) during ECMO treatment was evaluated .…”

Section: Discussionmentioning

confidence: 99%

What is new in pediatric ECMO? 2016, a year in review

Roeleveld

2017

European J of Heart Fail

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With the increasing use of extracorporeal membrane oxygenation in children come increasing publications concerning pediatric ECMO. In 2016 important work was done in identifying modifiable risk-factors and possible predictors of mortality in cardiac and respiratory ECMO and risk-estimation scores have been developed for respiratory ECMO patients. Also, increasing important experience is published in the areas of neurodevelopmental follow-up of ECMO survivors. The most relevant publications of 2016 are summarized in this review.

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“…Deleterious effects from overfeeding and underfeeding are well-documented. Malnutrition is reported to be associated with poor wound healing ( 5 ), loss of myocardial mass ( 6 ), and increased mortality ( 7 ), whilst excess nutrition has been found to be associated with steatosis and liver dysfunction ( 8 ). As such, optimization of nutrition is vital in the management of pediatric patients on ECMO.…”

Section: Introductionmentioning

confidence: 99%

Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

et al. 2021

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Extracorporeal membrane oxygenation (ECMO) support is increasingly utilized in quaternary pediatric intensive care units. Metabolic derangements and altered nutritional requirements are common in critically ill children supported on ECMO. However, there remains no consensus on the optimal approach to the prescription of nutrition in these patients. This narrative review aims to summarize the current medical literature on various aspects of nutrition support in pediatric patients on ECMO. These include: (1) nutritional adequacy, (2) pros and cons of feeding on ECMO, (3) enteral vs. parenteral nutrition, and (4) proposed recommendations and future directions for research in this area.

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Underweight Status Is an Independent Predictor of In‐Hospital Mortality in Pediatric Patients on Extracorporeal Membrane Oxygenation

Abstract: Underweight status was an independent predictor for in-hospital mortality in our cohort of pediatric ECMO patients. Prospective studies evaluating the impact of metabolic state of children on ECMO should further define this relationship.

Cited by 30 publications

References 36 publications

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

Early Enteral Nutrition and Gastrointestinal Complications in Pediatric Patients on Extracorporeal Membrane Oxygenation

What is new in pediatric ECMO? 2016, a year in review

Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

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