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

IF 2.5 2区医学 Q1 PEDIATRICS Journal of pediatric surgery Pub Date : 2025-04-01 Epub Date: 2025-01-23 DOI:10.1016/j.jpedsurg.2025.162189

Eduardo Fastag , Jhoanne Cana , Salem Dehom , Donald C. Moores , Mona S. Guglielmo , Cynthia H. Tinsley , Harsha K. Chandnani

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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Type of Study

Retrospective Cohort Study.

Level of Evidence

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儿科重症创伤患者早期与晚期肠内营养：一项回顾性队列研究。

目的：确定早期（入院后48小时内）肠内营养对儿童重症监护病房（PICU）住院时间（LOS）和呼吸机天数的影响，并确定开始肠内营养的相关障碍。方法：在一家三级PICU的一级儿科创伤中心进行回顾性队列研究，包括入院后48小时的所有患者。采用多变量负二项回归分析校正混杂因素，比较两组间PICU、医院LOS和机械通气天数的主要结局。结果：本研究共纳入238例受试者，分为早期肠内营养（EEN）组（n = 116）和晚期肠内营养（LEN）组（n = 122）。与LEN组相比，EEN组PICU LOS（调整发生率比（aIRR） 1.26, 95% CI 1.02-1.56, p = 0.030）和医院LOS （aIRR 1.36, 95% CI 1.10-1.69, p = 0.005）较短，机械通气天数无差异。结论：在控制病情严重程度、阿片类药物每日总剂量、血管活性药物的使用、损伤区域数量和手术次数后，入院PICU后发生EEN与PICU和医院LOS的降低有关，而对机械通气天数没有影响。研究类型：回顾性队列研究。证据等级：3；

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.