K. Ohman1, H. Zhu3, I. Maizlin4,10, D. Henry5, R. Ramirez6, L. Manning7, R. F. Williams7,8, Y. S. Guner6,11, R. T. Russell4,10, M. T. Harting5,9, A. M. Vogel2,3 1Washington University,Surgery,St. Louis, MO, USA 2Baylor College Of Medicine,Surgery,Houston, TX, USA 3Texas Children’s Hospital,Surgery,Houston, TX, USA 4The Children’s Hospital Of Alabama,Surgery,Birmingham, AL, USA 5Children’s Memorial Hermann Hospital,Surgery,Houston, TX, USA 6Children’s Hospital of Orange County,Surgery,Orange, CALIFORNIA, USA 7LeBonheur Children’s Hospital,Surgery,Memphis, TN, USA 8Univeristy Of Tennessee Health Science Center,Surgery,Memphis, TN, USA 9McGovern Medical School at UTHealth,Pediatric Surgery,Houston, TX, USA 10University Of Alabama at Birmingham,Surgery,Birmingham, Alabama, USA 11University Of California – Irvine,Surgery,Orange, CA, USA
Introduction: Extracorporeal life support (ECLS) allows for life saving treatment for critically ill neonates and children. Malnutrition in critically ill patients is extremely common and is associated with increased morbidity and mortality. The purpose of this study is to describe nutritional practice patterns of parenteral (PN) and enteral (EN) nutrition and nutritional adequacy of neonates and children receiving ECLS. We hypothesize that nutritional adequacy is highly variable, overall nutritional adequacy is poor, and enteral nutrition is underutilized compared to parenteral nutrition.
Methods: An IRB approved, retrospective study of neonates and children (age<18 years) receiving ECLS at 5 centers from 2012 to 2014 was performed. Demographic, clinical, and outcome data were analyzed. Continuous variables are presented as median [IQR]. Adequate nutrition was defined as meeting 66% of daily caloric goals during ECLS support.
Results: 283 patients were identified; the median age was 12 days [3 days, 16.4 years] and 47% were male. ECLS categories were neonatal respiratory 33.9%, neonatal cardiac 25.1%, pediatric respiratory 17.7%, and pediatric cardiac 23.3%. The predominant mode was venoarterial (70%). Mortality was 41%. Pre-ECLS enteral and parenteral nutrition was present in 80% and 71.5% of patients, respectively. The median caloric and protein goals for the population were 90 kcals/kg [70, 100] and 3 grams/kg [2, 3], respectively. Figure 1 shows goal, caloric and protein nutritional adequacy for the population over the duration of ECLS. The median percent days of adequate caloric and protein nutrition were 50% [0, 78] and 67% [22, 86], respectively. The median percent days with adequate caloric and protein nutrition by the enteral route alone was 22% [0, 65] and 0 [0, 50], respectively. Gastrointestinal complications occurred in 19.7% of patients including: hemorrhage (4.2%), ileus (3.2%), enterocolitis (2.5%), intraabdominal hypertension or compartment syndrome (0.7%), perforation (0.4%), and other (11%).
Conclusion: Although nutritional adequacy in neonates and children that receive ECLS improves over the course of the ECLS run, the use of enteral nutrition is remains low despite relatively infrequent gastrointestinal complications.
