Early Versus Late Enteral Nutrition in the Pediatric Critically-Ill Trauma Patient: A Retrospective Cohort Study

• Published in: Journal of pediatric surgery Vol. 60; no. 4; p. 162189
• Main Authors: Fastag, Eduardo, Cana, Jhoanne, Dehom, Salem, Moores, Donald C., Guglielmo, Mona S., Tinsley, Cynthia H., Chandnani, Harsha K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2025
• Subjects: Adolescent; Child; Child, Preschool; Children; Critical Illness - therapy; Enteral Nutrition - methods; Enteral Nutrition - statistics & numerical data; Female; Humans; Infant; Intensive Care Units, Pediatric - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Nutrition; Outcomes; Pediatric; Respiration, Artificial - statistics & numerical data; Retrospective Studies; Time Factors; Trauma; Wounds and Injuries - therapy; VIS; GI; PRISM-III; Nutrition; MME; aIRR; ISS; Trauma; Outcomes; PICU; EEN; PPN; TPN; LEN; VPS; Children; PIM2; SCCM; Pediatric; ASPEN; PN
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2025.162189

To determine the effect of early (within 48 h of admission) enteral nutrition on length of stay (LOS) and number of ventilator days in the pediatric intensive care unit (PICU) and identify associated barriers to initiation of enteral nutrition. A retrospective cohort study at a level 1 pediatric trauma center with a tertiary care PICU including all patients <18 years of age admitted with traumatic injuries, classified into an early enteral nutrition group vs. late enteral nutrition (>48 h from admission). Primary outcomes of PICU and Hospital LOS and days on mechanical ventilation were compared between groups using multivariable negative binomial regression analysis to correct for confounding factors. A total of 238 subjects were included in our study and then classified as either the early enteral nutrition (EEN) group (n = 116) or the late enteral nutrition (LEN) group (n = 122). Compared to the LEN group, the EEN group had a shorter PICU LOS (adjusted incidence rate ratio (aIRR) 1.26, 95 % CI 1.02–1.56, p = 0.030) and hospital LOS (aIRR 1.36, 95 % CI 1.10–1.69, p = 0.005), with no difference in number of days on mechanical ventilation. Initiation of EEN after admission to the PICU is associated with decreased PICU and hospital LOS with no effect on mechanical ventilation days after controlling for severity of illness, opioid total daily dose, use of vasoactive medications, number of regions injured and number of surgical procedures performed. Retrospective Cohort Study. 3. •There is no association of early enteral feeding with a reduction in days of mechanical ventilation.•Initiation of enteral feeds in critically-ill pediatric trauma patients within 48 h of admission is associated with decreased PICU and Hospital LOS.•This association remains after controlling for severity of illness, use of opioid and vasoactive medications, and presence of abdominal trauma.•Severity of illness, abdominal site of trauma, and medications affecting gastric mobility or perfusion such as opiods or vasoactive medications may be barriers to the initiation of early enteral feeding in the pediatric trauma population.