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Impact of Early Initiation of Enteral Nutrition on Survival During Pediatric Extracorporeal Membrane Oxygenation
Author(s) -
Greathouse Kristin C.,
Sakellaris Kelly T.,
Tumin Dmitry,
Katsnelson Jacob,
Tobias Joseph D.,
Hayes Don,
Yates Andrew R.
Publication year - 2018
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1032
Subject(s) - medicine , extracorporeal membrane oxygenation , parenteral nutrition , enteral administration , retrospective cohort study , inotrope , demographics , intensive care medicine , surgery , demography , sociology
Abstract Introduction : Pediatric data related to safety, tolerance, and outcomes of enteral nutrition (EN) for patients requiring extracorporeal membrane oxygenation (ECMO) are lacking. The objectives of this study were to evaluate early nutrition status and timing of EN initiation on survival during pediatric ECMO. Methods : A single center institutional review board–approved retrospective chart review was performed on all pediatric patients requiring ECMO from October 2008 through December 2013. Demographics, ECMO variables, laboratory values, vasoactive inotropic score (VIS), and nutrition data on day 5 (d5) were collected. Patients receiving parenteral nutrition (PN) were compared with those receiving any EN on d5. Analyses were conducted to identify factors influencing survival to completion of ECMO and to discharge. Results : Forty‐nine patients aged 53 ± 76 months met inclusion criteria. Kaplan‐Meier curves demonstrated greater survival to discharge in patients receiving any EN, compared with only receiving PN ( P = .031). EN on d5 of ECMO support ( P = .040) and a higher percentage of daily energy intake achieved ( P = .013) were protective, whereas a higher VIS was associated with increased mortality ( P = .010). Multivariable analysis demonstrated EN was no longer associated with survival to discharge ( P = .139), whereas energy intake ( P = .021) and VIS ( P = .013) remained significant. Conclusions : Pediatric patients who received nutrition that was closer to goal energy intake, as well as those who received any EN early during ECMO, had improved survival to hospital discharge.