Anthony Alexander Sochet1,2, Jessica Ann McGee3, Tessie Wazeerah October2,4. 1. Johns Hopkins All Children's Hospital, St Petersburg, Florida; asochet1@jhmi.edu. 2. The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and. 3. Johns Hopkins All Children's Hospital, St Petersburg, Florida. 4. Children's National Health System, Washington, District of Columbia.
Abstract
OBJECTIVES: To determine the incidence of aspiration-related respiratory failure and nutrition interruptions in children with bronchiolitis on high-flow nasal cannula (HFNC) receiving enteral nutrition. METHODS: We performed a single-center, prospective, observational cohort study within a 313-bed tertiary medical center from January through December 2015. We included term children 1 month to 2 years of age without comorbid bacterial pneumonia or chronic medical conditions who were diagnosed with bronchiolitis while receiving HFNC and enteral nutrition. Primary outcomes were incidence of aspiration-related respiratory failure and nutrition interruptions. Secondary outcomes were duration of HFNC therapy, length of stay, and nutrition characteristics. RESULTS: Of the 344 children admitted with bronchiolitis, 132 met the inclusion criteria. Ninety-seven percent received enteral nutrition by mouth and 3% by nasogastric tube. HFNC flow rates at the time of nutrition initiation ranged between 4 and 13 L per minute (0.3-1.9 L/kg per minute) and respiratory rates from 18 to 69 breaths per minute. One (0.8%) subject had aspiration-related respiratory failure and 12 (9.1%) experienced nutrition interruptions. Children with interruptions in nutrition had a longer length of stay by 2.5 days (P < .01) and received an additional day of HFNC therapy (P < .01). By discharge, 55 (42%) children achieved all nutritional goals: caloric, volume, and protein. Children admitted overnight had an increased incidence of delay to nutrition initiation (30% vs 11%; P < .01). CONCLUSIONS: We observed a low incidence of aspiration-related respiratory failure in term children with bronchiolitis on HFNC receiving enteral nutrition. Oral nutrition was tolerated across a range of HFNC flow and respiratory rates, suggesting the practice of withholding nutrition in this population is unsupported.
OBJECTIVES: To determine the incidence of aspiration-related respiratory failure and nutrition interruptions in children with bronchiolitis on high-flow nasal cannula (HFNC) receiving enteral nutrition. METHODS: We performed a single-center, prospective, observational cohort study within a 313-bed tertiary medical center from January through December 2015. We included term children 1 month to 2 years of age without comorbid bacterial pneumonia or chronic medical conditions who were diagnosed with bronchiolitis while receiving HFNC and enteral nutrition. Primary outcomes were incidence of aspiration-related respiratory failure and nutrition interruptions. Secondary outcomes were duration of HFNC therapy, length of stay, and nutrition characteristics. RESULTS: Of the 344 children admitted with bronchiolitis, 132 met the inclusion criteria. Ninety-seven percent received enteral nutrition by mouth and 3% by nasogastric tube. HFNC flow rates at the time of nutrition initiation ranged between 4 and 13 L per minute (0.3-1.9 L/kg per minute) and respiratory rates from 18 to 69 breaths per minute. One (0.8%) subject had aspiration-related respiratory failure and 12 (9.1%) experienced nutrition interruptions. Children with interruptions in nutrition had a longer length of stay by 2.5 days (P < .01) and received an additional day of HFNC therapy (P < .01). By discharge, 55 (42%) children achieved all nutritional goals: caloric, volume, and protein. Children admitted overnight had an increased incidence of delay to nutrition initiation (30% vs 11%; P < .01). CONCLUSIONS: We observed a low incidence of aspiration-related respiratory failure in term children with bronchiolitis on HFNC receiving enteral nutrition. Oral nutrition was tolerated across a range of HFNC flow and respiratory rates, suggesting the practice of withholding nutrition in this population is unsupported.
Authors: H J Zar; D P Moore; S Andronikou; A C Argent; T Avenant; C Cohen; R J Green; G Itzikowitz; P Jeena; R Masekela; M P Nicol; A Pillay; G Reubenson; S A Madhi Journal: Afr J Thorac Crit Care Med Date: 2020-10-13
Authors: Milena Siciliano Nascimento; Danielle E R Quinto; Gisele C Z Oliveira; Celso M Rebello; Cristiane do Prado Journal: Sci Rep Date: 2020-09-28 Impact factor: 4.379