Fellow University of Arkansas for Medical Sciences University of Arkansas for Medical Sciences Little Rock, Arkansas, United States
Background: Malnutrition is associated with adverse clinical outcomes, including longer mechanical ventilation, higher risk of hospital-acquired infection, longer pediatric intensive care unit (PICU) and hospital length of stay (LOS), and increased mortality.
Objective: We aimed to examine the current practice of enteral nutrition initiation in critically ill pediatric trauma patients to evaluate the factors associated with "early" versus "late" initiation of enteral nutrition.
Design/Methods: We performed a retrospective chart review of trauma patients admitted to the PICU at a quaternary care, level 1 trauma accredited children's hospital between January 1, 2016 and December 31, 2019. Patients 0 to 18 years were included. We compared demographics, timing of enteral nutrition intitation and achievement of caloric intake goal, trauma injury severity score (ISS), emergency department (ED) Glasgow coma scale (GCS) score, PICU LOS, ventilator days, and completion of child abuse evaluation between patients. Univariate analysis was used to evaluate variables associated with delayed intitation of enteral feeds.
Results: 319 patients were analyzed in our study with a mortality of 11.9% overall. 81.3% of patients were fed "early", defined as within 48 hours of PICU admission. Table 1 shows that higher trauma ISS and lower GCS scores were significantly associated with "late" (greater than 48 hours after PICU admission) initiation of enteral nutrition. Late initiation of feeds was associated with an increase in PICU LOS and a longer time to caloric intake goal. Conclusion(s): Critically ill pediatric trauma patients with higher trauma ISS and lower GCS scores were more likely to have delayed initiation of enteral nutrition, potentially exposing them to the adverse effects of malnutrition. Delayed enteral nutrition was associated with a longer time to caloric intake goal and an increase in PICU LOS. Further statistical analysis of variables related to timing of enteral nutrition intiation, such as surgical procedures, inotrope requirement, and type of traumatic injury, is ongoing in addition to multivariate analysis.
Authors/Institutions: Cassandra L. Louis, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States; Clark Sims, Arkansas Children's Nutrition Center, Little Rock, Arkansas, United States; Aline Andres, Arkansas Children's Nutrition Center, Little Rock, Arkansas, United States; Robert T. Maxson, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States; Matthew P. Malone, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States