Premium
Nutrition Delivery During Pediatric Extracorporeal Membrane Oxygenation Therapy
Author(s) -
Armstrong Lindsey B.,
Ariagno Katelyn,
Smallwood Craig D.,
Hong Charles,
Arbuthnot Mary,
Mehta Nilesh M.
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.1154
Subject(s) - medicine , interquartile range , extracorporeal membrane oxygenation , parenteral nutrition , medical nutrition therapy , enteral administration , anesthesia , pediatrics , surgery
Background Macronutrient delivery during pediatric ECMO therapy can be challenging. We examined predictors of nutrient delivery in the first 2 weeks of extracorporeal membrane oxygenation (ECMO) therapy in the pediatric intensive care unit (ICU). Methods Details of macronutrient delivery were recorded in children (newborn–18 years of age) who survived 24 hours after cannulation to ECMO over a 3‐year period (2012–2015). Results We analyzed data from 54 consecutive eligible patients, 43% female, with median (interquartile range) ECMO duration of 8.5 (6–24) days, age 0.1 (0, 16) months, ICU length of stay 32 (21, 60) days, and 28‐day mortality 13%. Median weight for age z score declined from −0.1 at admission to −1.2 at 30 days ( P = 0.013). At least 80% goal energy and protein was delivered in 35 (65%) and 33 (61%) patients, respectively, by day 7; 10% of energy and 11% protein goal was delivered enterally. Parenteral nutrition (PN) was utilized in 47 (87%) patients, initiated by day 1 (1, 3). Enteral nutrition (EN) was successfully delivered in 49 (94%) patients (35% postpyloric), initiated by day 6 (2, 16). Younger age ( P = 0.01) and venoarterial mode of ECMO ( P = 0.0014) were associated with lower EN delivery. Use of umbilical artery catheters or vasoactive infusions did not impede EN delivery. Late PN delivery was associated with cumulative protein deficits ( P = 0.019) and failure to achieve nutrient delivery goals by day 7. Conclusions Optimal nutrient delivery was achieved in most patients by day 7, predominantly via PN. Early EN is feasible in low volumes, but PN may be essential to prevent cumulative energy and protein deficits during the first week of ECMO.