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Nomogram to predict feeding intolerance in critically ill children

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Abstract

Feed intolerance (FI) is significantly associated with poor prognosis in critically ill patients. This study aimed to understand the characteristics of children with FI and identify the factors predicting FI in critically ill children. This retrospective cohort study was conducted between January 2017 and June 2022 in the Pediatric Intensive Care Unit of a specialized children’s hospital. Eighteen factors, including age, body mass index for age z-score (BAZ) < -2, paediatric index of mortality (PIM)3 score, Glasgow coma scale score, mechanical ventilation (MV), enteral nutrition delay, vasoactive drugs, sedatives, sepsis, heart disease, neurological disease, hypokalemia, arterial PH < 7.35, arterial partial pressure of oxygen (PaO2), blood glucose, hemoglobin, total protein, and albumin, were retrieved to predict FI. The outcome was FI during PICU stay. During the study period, a total of 854 children were included, of which 215 children developed FI. Six predictors of FI were selected: PIM3 score, MV, sepsis, hypokalemia, albumin, and PaO2. Multivariate logistic regression analysis showed that higher PIM3 score, MV, sepsis, hypokalemia, and lower PaO2 were independent risk factors for FI, whereas higher albumin was an independent protective factor for FI. The C-index of the predictive nomogram of 0.943 was confirmed at internal validation to be 0.940, indicating a good predictive value of the model. Decision curve analysis shows good clinical applicability of the nomogram in predicting FI.

   Conclusion: The nomogram was verified to have a good prediction performance based on discrimination, calibration, and clinical decision analysis.

What is Known:

• Research has demonstrated that gastrointestinal (GI) dysfunction is not only a fundamental element of Multiple Organ Dysfunction Syndrome (MODS), but also the initiator of MODS.

• Previous study has demonstrated a significant association between FI and poor prognosis in critically ill patients.

What is New:

• We excluded patients with primary gastrointestinal tract disease from our study, and we observed an incidence of FI of 25.2% in the Pediatric Intensive Care Unit (PICU).

• Our study revealed that PIM3 score, MV, sepsis, hypokalemia, albumin, and PaO2 are significant predictors of FI.

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Availability of data and materials

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

BAZ:

Body mass index for age z-score

DCA:

Decision curve analysis

EN:

Enteral nutrition

FI:

Feed intolerance

GCS:

Glasgow coma scale

GI:

Gastrointestinal

ICU:

Intensive care unit

LASSO:

Least absolute shrinkage and selection operator

MODS:

Multiple Organ Dysfunction Syndrome

MV:

Mechanical ventilation

PaO2 :

Arterial partial pressure of oxygen

PICU:

Pediatric Intensive Care Unit

PIM:

Paediatric index of mortality

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Acknowledgements

We appreciate all of participants who enrolled in this study.

Funding

This work was funded by Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-040A) and Tianjin Natural Science Fund (21JCYBJC00890).

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Authors and Affiliations

  1. Department of Nutrition, Tianjin Children’s Hospital /Tianjin University Children’s Hospital, 225 Longyan Rd, Beichen Dist, Tianjin, China

    Ying Lin, Lingyan Li, Yun Gou & Junhong Yang

  2. Pediatric Intensive Care Unit, Tianjin Children’s Hospital /Tianjin University Children’s Hospital, Tianjin, China

    Xiaomin Wang, Liping Zhang & Lijing Wang

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  1. Ying Lin
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Contributions

Ying Lin designed the research.Ying Lin, Junhong Yang, and Xiaomin Wang conducted the research.Ying Lin and Junhong Yang provided data analysis.Ying Lin, Liping Zhang, Lijing Wang, Lingyan Li, and Yun Gou conducted data collection.Liping Zhang and Lijing Wang provided data interpretation.Ying Lin drafted the manuscript. Junhong Yang and Xiaomin Wang revised the manuscript. All authors contributed to writing and editing the final paper.

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Correspondence to Ying Lin.

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Ethical approval

The study was conducted in accordance with the ethical principles laid down in the “Declaration of Helsinki”. It was approved by the hospital Ethics Committee (Ethics Committee of Tianjin Children’s Hospital, No.: L2023-005). Due to the retrospective nature of this study, the ethics committee was exempted from signing the subject informed consent form.

Competing interests

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

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Communicated by Peter de Winter

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Lin, Y., Wang, X., Li, L. et al. Nomogram to predict feeding intolerance in critically ill children. Eur J Pediatr 182, 5293–5302 (2023). https://doi.org/10.1007/s00431-023-05205-8

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