Binod Balakrishnan1, Katherine T Flynn-O'Brien2, Pippa M Simpson3, Mahua Dasgupta3, Sheila J Hanson4. 1. Division of Critical Care, Department of Pediatrics, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA. SHanson@mcw.edu. 2. Department of Surgery, University of Washington, Seattle, WA, USA. 3. Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. 4. Division of Critical Care, Department of Pediatrics, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
Abstract
BACKGROUND: Traumatic brain injury (TBI) is the leading cause of death and long-term disability among injured children. Early feeding has been shown to improve outcomes in adults, with some similar evidence in children with severe TBI. We aimed to examine the current practice of initiation of enteral nutrition in children with TBI and to evaluate the risk factors associated with delayed initiation of enteral nutrition. METHODS: This retrospective, multicenter study used the Pediatric Trauma Assessment and Management Database including all children with head trauma discharged from five pediatric intensive care units (PICU) at pediatric trauma centers between January 1, 2013 and December 31, 2013. We compared demographics, injury and procedure data, time to initiation of nutrition, and injury and illness severity scores between patients who received enteral nutrition early (≤ 48 h) and late (> 48 h). Fisher's exact and Mann-Whitney U tests compared discrete and continuous variables. Univariate and multivariable analyses evaluated variables associated with delayed initiation of feeding. Outcomes of interest included mortality, complications, ventilator days, hospital and ICU length of stay, and functional status at ICU discharge. RESULTS: In the 416 patients in the study, the overall mortality was 2.6%. The majority of patients (83%; range 69-88% between five sites, p = 0.0008) received enteral nutrition within 48 h of PICU admission. Lower Glasgow Coma Scale scores and higher Injury Severity Score (ISS) were independently associated with delayed initiation of enteral nutrition. Delayed enteral nutrition was independently associated with worse functional status at PICU discharge (p = 0.02) but was not associated with mortality or increased length of stay. CONCLUSIONS: Children with severe TBI and higher ISS were more likely to have delayed initiation of enteral nutrition. Delayed enteral nutrition was an independent risk factor for worse functional status at ICU discharge for the entire cohort, but not for the severe TBI group.
BACKGROUND:Traumatic brain injury (TBI) is the leading cause of death and long-term disability among injured children. Early feeding has been shown to improve outcomes in adults, with some similar evidence in children with severe TBI. We aimed to examine the current practice of initiation of enteral nutrition in children with TBI and to evaluate the risk factors associated with delayed initiation of enteral nutrition. METHODS: This retrospective, multicenter study used the Pediatric Trauma Assessment and Management Database including all children with head trauma discharged from five pediatric intensive care units (PICU) at pediatric trauma centers between January 1, 2013 and December 31, 2013. We compared demographics, injury and procedure data, time to initiation of nutrition, and injury and illness severity scores between patients who received enteral nutrition early (≤ 48 h) and late (> 48 h). Fisher's exact and Mann-Whitney U tests compared discrete and continuous variables. Univariate and multivariable analyses evaluated variables associated with delayed initiation of feeding. Outcomes of interest included mortality, complications, ventilator days, hospital and ICU length of stay, and functional status at ICU discharge. RESULTS: In the 416 patients in the study, the overall mortality was 2.6%. The majority of patients (83%; range 69-88% between five sites, p = 0.0008) received enteral nutrition within 48 h of PICU admission. Lower Glasgow Coma Scale scores and higher Injury Severity Score (ISS) were independently associated with delayed initiation of enteral nutrition. Delayed enteral nutrition was independently associated with worse functional status at PICU discharge (p = 0.02) but was not associated with mortality or increased length of stay. CONCLUSIONS:Children with severe TBI and higher ISS were more likely to have delayed initiation of enteral nutrition. Delayed enteral nutrition was an independent risk factor for worse functional status at ICU discharge for the entire cohort, but not for the severe TBI group.
Authors: Theresa A Mikhailov; Evelyn M Kuhn; Jennifer Manzi; Melissa Christensen; Maureen Collins; Ann-Marie Brown; Ronald Dechert; Matthew C Scanlon; Martin K Wakeham; Praveen S Goday Journal: JPEN J Parenter Enteral Nutr Date: 2014-01-08 Impact factor: 4.016
Authors: Patrick M Kochanek; Nancy Carney; P David Adelson; Stephen Ashwal; Michael J Bell; Susan Bratton; Susan Carson; Randall M Chesnut; Jamshid Ghajar; Brahm Goldstein; Gerald A Grant; Niranjan Kissoon; Kimberly Peterson; Nathan R Selden; Robert C Tasker; Karen A Tong; Monica S Vavilala; Mark S Wainwright; Craig R Warden Journal: Pediatr Crit Care Med Date: 2012-01 Impact factor: 3.624
Authors: Julia K Shinnick; Heather L Short; Kurt F Heiss; Matthew T Santore; Martin L Blakely; Mehul V Raval Journal: J Surg Res Date: 2016-01-12 Impact factor: 2.192
Authors: Belinda J Gabbe; Pam M Simpson; Ann M Sutherland; Cameron S Palmer; Owen D Williamson; Warwick Butt; Catherine Bevan; Peter A Cameron Journal: J Trauma Date: 2011-06
Authors: Nilesh M Mehta; Dianne McAleer; Susan Hamilton; Elizabeth Naples; Kristen Leavitt; Paul Mitchell; Christopher Duggan Journal: JPEN J Parenter Enteral Nutr Date: 2009-11-10 Impact factor: 4.016
Authors: Elizabeth Meinert; Michael J Bell; Sandra Buttram; Patrick M Kochanek; Goundappa K Balasubramani; Stephen R Wisniewski; P David Adelson Journal: Pediatr Crit Care Med Date: 2018-04 Impact factor: 3.624
Authors: Michael F Canarie; Suzanne Barry; Christopher L Carroll; Amanda Hassinger; Sarah Kandil; Simon Li; Matthew Pinto; Stacey L Valentine; E Vincent S Faustino Journal: Pediatr Crit Care Med Date: 2015-10 Impact factor: 3.624
Authors: Lyvonne N Tume; Frederic V Valla; Koen Joosten; Corinne Jotterand Chaparro; Lynne Latten; Luise V Marino; Isobel Macleod; Clémence Moullet; Nazima Pathan; Shancy Rooze; Joost van Rosmalen; Sascha C A T Verbruggen Journal: Intensive Care Med Date: 2020-02-20 Impact factor: 17.440
Authors: Tamy Colonetti; Maria Laura R Uggioni; Sarah D Ferraz; Marina C Rocha; Mateus V Cruz; Maria Inês da Rosa; Antonio J Grande Journal: Nutrients Date: 2021-03-30 Impact factor: 5.717