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Association of enteral feeds in critically ill bronchiolitis patients supported by high-flow nasal cannula with adverse events and outcomes

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Abstract

To study association of enteral feeds in bronchiolitis patients supported by different levels of high flow nasal cannula (HFNC) with adverse events, nutritional goals, and clinical outcomes. Bronchiolitis patients ≤ 24 months of age treated with < 1 L/kg/min, 1–2 L/kg/min and > 2 L/kg/min of HFNC between January 2014 and December 2021 were studied retrospectively at a tertiary care children’s hospital. Adverse events (aspiration pneumonia, emesis, and respiratory support escalation), nutritional goals (initiation of enteral feeds, achievement of nutritional goal volume and goal calories, percentage weight change during hospital stay) and clinical outcomes (HFNC duration, oxygen supplementation duration after HFNC, length of hospital stay following HFNC support, total length of hospital stay and follow-up for 1 month after hospital discharge) were compared between fed and non-fed patients on HFNC. Six hundred thirty-six (489 fed and 147 not-fed) bronchiolitis patients on HFNC studied. 260 patients, 317 patients and 59 patients were supported by < 1 L/kg/min, 1–2 L/kg/min and > 2 L/kg/min of HFNC, respectively. Enterally fed patients had significantly less adverse events (OR = 0.14, 95% CI 0.083 – 0.23, p < 0.001), significantly better nutritional goals: earlier initiation of enteral feeds by 65% in time (mean ratio = 0.35, 95% CI 0.28 – 0.43, p < 0.001), earlier achievement of goal volume and goal calorie needs by 14% in time (mean ratio = 0.86, 95% CI 0.78 to 0.96, p = 0.005) and significantly better clinical outcomes: shorter HFNC duration by 29.75 h (95% CI 20.19 -39.31, p < 0.001), shorter oxygen supplementation duration after HFNC by 12.14 h (95% CI 6.70 -17.59, p < 0.001), shorter length of hospital stay after HFNC support by 21.35 h (95% CI 14.71–27.98, p < 0.001) and shorter total length of hospital stay by 51.10 h (95% CI 38.65 -63.55, p < 0.001), as compared to non-fed patients, after adjusting for age, weight, prematurity, comorbidities, admission time, admission bronchiolitis score, admission respiratory rate, and HFNC levels. The number of revisits and readmissions at 7 and 30 days after hospital discharge were not significantly different (p > 0.05) between the fed and non-fed groups.

   Conclusion: Enteral feeding of bronchiolitis patients supported by different levels of HFNC is associated with less adverse events and better nutrition goals and clinical outcomes.

What is Known:

•There is general apprehension to feed critically ill bronchiolitis patients supported by high flow nasal cannula.

What is New:

•Our study reveals that enteral feeding of critically ill bronchiolitis patients supported by different levels of high flow nasal cannula is associated with minimal adverse events, better nutritional goals and improved clinical outcomes as compared to non-fed patients.

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Data availability

Data availability will be provided at request to the corresponding author.

Abbreviations

BiPAP:

Bilevel positive airway pressure support

CPAP:

Continuous positive airway pressure support

HFNC:

High Flow Nasal Cannula

IQR:

Interquartile range

PICU:

Pediatric Intensive Care Unit

RSE:

Respiratory support escalation

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Authors and Affiliations

  1. Department of Pediatric Emergency Medicine, Akron Children’s Hospital, Akron, OH, USA

    Reem Sarkis

  2. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Wei Liu

  3. Department of Pediatric Gastroenterology, Cleveland Clinic Children’s, Cleveland, OH, USA

    Christina DeTallo

  4. Department of Pediatric Critical Care Medicine, Cleveland Clinic Children’s, Cleveland, OH, USA

    Orkun Baloglu & Samir Q. Latifi

  5. Department of Pediatric Critical Care Medicine, Cardinal Glennon Children’s Hospital, Division of Pediatric Critical Care, 1465 South Grand Boulevard, Suite 2601 F, Saint Louis, MO, 63104, USA

    Hemant S. Agarwal

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Reem Sarkis, Wei Liu, and Hemant Agarwal. The first draft of the manuscript was written by Reem Sarkis, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hemant S. Agarwal.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of The Cleveland Clinic Foundation (CCF) Institutional Review Board (IRB) (Date 3/17/2022 /No # 21-303).

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The authors have no relevant financial or non-financial interests to disclose.

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Sarkis, R., Liu, W., DeTallo, C. et al. Association of enteral feeds in critically ill bronchiolitis patients supported by high-flow nasal cannula with adverse events and outcomes. Eur J Pediatr 182, 4015–4025 (2023). https://doi.org/10.1007/s00431-023-05085-y

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