Intermittent versus continuous enteral nutrition in critically ill children: A pre-planned secondary analysis of an international prospective cohort study

Enid E. Martinez, Lori J. Bechard, Ann Marie Brown, Jorge A. Coss-Bu, Sapna R. Kudchadkar, Theresa A. Mikhailov, Vijay Srinivasan, Steven J. Staffa, S. (Sascha) C.A.T. Verbruggen, David Zurakowski, Nilesh M. Mehta*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Background & aims: Intermittent enteral nutrition (EN) may have physiologic benefits over continuous feeding in critical illness. We aimed to compare nutrition and infection outcomes in critically ill children receiving intermittent or continuous EN. Methods: International, multi-center prospective observational study of mechanically ventilated children, 1 month to 18 years of age, receiving EN. Percent energy or protein adequacy (energy or protein delivered/prescribed × 100) and acquired infection rates were compared between intermittent and continuous EN groups using adjusted-multivariable and 4:1 propensity-score matched (PSM) analyses. Sensitivity analyses were performed after excluding patients who crossed over between intermittent and continuous EN. Results: 1375 eligible patients from 66 PICUs were included. Patients receiving continuous EN (N = 1093) had a higher prevalence of respiratory illness and obesity, and lower prevalence of neurologic illness and underweight status on admission, compared to those on intermittent EN (N = 282). Percent energy or protein adequacy, proportion of patients who achieved 60% of energy or protein adequacy in the first 7 days of admission, and rates of acquired infection were not different between the 2 groups in adjusted-multivariable and propensity score matching analyses (P > 0.05). Conclusion: Intermittent versus continuous EN strategy is not associated with differences in energy or protein adequacy, or acquired infections, in mechanically ventilated, critically ill children. Until further evidence is available, an individualized feeding strategy rather than a universal approach may be appropriate.

Original languageEnglish
Pages (from-to)2621-2627
Number of pages7
JournalClinical Nutrition
Volume41
Issue number12
DOIs
Publication statusPublished - 1 Dec 2022

Bibliographical note

Funding Information:
The study was partly funded by the ASPEN Rhoads Research Foundation and the Payer-Provider Quality Initiative Grant at Boston Children's Hospital. Dr. Martinez was funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases K23DK128634 Award. Dr. Mehta was funded by National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases R01DK132348-01 award.

Publisher Copyright: © 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

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