Blog Viewer

Enteral Nutrition Initiation in Children Admitted to Pediatric Intensive Care Units After Traumatic Brain Injury

By Currents Editor posted 02-11-2019 14:21

  

By Binod Balakrishnan, Katherine T. Flynn-O’Brien, Pippa M. Simpson, Mahua Dasgupta, Sheila J. Hanson

Background

Traumatic brain injury (TBI) is the leading cause of death and long-term disability among injured children. Early feeding has been shown to improve outcomes in adults, with some similar evidence in children with severe TBI. We aimed to examine the current practice of initiation of enteral nutrition in children with TBI and to evaluate the risk factors associated with delayed initiation of enteral nutrition.

Methods

This retrospective, multicenter study used the Pediatric Trauma Assessment and Management Database including all children with head trauma discharged from five pediatric intensive care units (PICU) at pediatric trauma centers between January 1, 2013 and December 31, 2013. We compared demographics, injury and procedure data, time to initiation of nutrition, and injury and illness severity scores between patients who received enteral nutrition early (≤ 48 h) and late (> 48 h). Fisher’s exact and Mann–Whitney U tests compared discrete and continuous variables. Univariate and multivariable analyses evaluated variables associated with delayed initiation of feeding. Outcomes of interest included mortality, complications, ventilator days, hospital and ICU length of stay, and functional status at ICU discharge.

Results

In the 416 patients in the study, the overall mortality was 2.6%. The majority of patients (83%; range 69–88% between five sites, p = 0.0008) received enteral nutrition within 48 h of PICU admission. Lower Glasgow Coma Scale scores and higher Injury Severity Score (ISS) were independently associated with delayed initiation of enteral nutrition. Delayed enteral nutrition was independently associated with worse functional status at PICU discharge (p = 0.02) but was not associated with mortality or increased length of stay.

Conclusions

Children with severe TBI and higher ISS were more likely to have delayed initiation of enteral nutrition. Delayed enteral nutrition was an independent risk factor for worse functional status at ICU discharge for the entire cohort, but not for the severe TBI group.

Read more

#NCJ

FURTHER READING
By Roy Poblete, MD, David Seder, MD, Gene Sung, MD     Since the first Emergency Neurologic Life Support (ENLS) course, there has always been a great deal of interest in developing an advanced learning follow-up course. The Neurocritical Care Society is now proud to present the brand-new ...
The Currents Editorial Board is seeking Stories of Hope submissions for 2020. Stories of Hope tells the stories of patients who have fought their way to recovery and the experiences of their family and/or medical providers. By sharing these stories, we remind each other of what we are all working ...
By Pouya Alexander Ameli, MD, MS Neurocritical Care Fellow, Emory University Chair-Elect, Trainee Section   Naomi Niznick, MD PGY3 Neurology Resident, The Ottawa Hospital Trainee Section Leadership Committee     In Homer’s The Odyssey , Odysseus asks for his friend “Mentor” to watch ...