J Pediatr Intensive Care
DOI: 10.1055/s-0042-1744296
Original Article

Impact of Early Enteral Nutrition on the Hospital Stay of Pediatric Patients Undergoing Mechanical Ventilation

Marcelo Sebastian Carpio Zevallos
1   School of Medicine, Universidad Peruana de Ciencias Aplicadas, Santiago de Surco, Peru
Katherine Susana Sobrado Jara
1   School of Medicine, Universidad Peruana de Ciencias Aplicadas, Santiago de Surco, Peru
Cielo Arminda Cabanillas Ramírez
1   School of Medicine, Universidad Peruana de Ciencias Aplicadas, Santiago de Surco, Peru
1   School of Medicine, Universidad Peruana de Ciencias Aplicadas, Santiago de Surco, Peru
2   Intensive Care Unit, Hospital de Emergencias Pediatricas, Lima, Peru
› Author Affiliations
Funding None.


Early initiation of enteral nutrition (EN) in pediatrics has been associated with improved clinical outcomes in critically ill pediatric patients. This research study aimed to measure the effect of early EN in intubated children on the length of stay (LOS) and days of mechanical ventilation (DMV). A retrospective cohort observational study was performed on patients admitted to the pediatric intensive care unit (PICU). We gathered the information from available medical records. Our exposure variable was EN, which can be classified as either early-onset (less than 72 hours following PICU admission) or late-onset (greater than or equal to 72 hours following PICU admission). The response variables were LOS defined as the period of time from either hospital or PICU admission to the time of hospital discharge and DMV defined as the length of time from endotracheal intubation to successful extubation. Late EN was associated with an increase in both hospital LOS consisting of 9.82 days and PICU LOS consisting of 5.89 days, and DMV consisting of 3.92 days compared with those patients receiving early EN. In addition, the disruption of EN was also associated with an increased hospital LOS consisting of 10.7 days. Patients in the PICU, undergoing mechanical ventilation, who received late EN have an increased risk of unfavorable outcomes consisting of prolonged hospital LOS, PICU-LOS, and DMV which may be further aggravated by any disruption of EN.

Publication History

Received: 19 October 2021

Accepted: 27 January 2022

Article published online:
08 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Naber TH, Schermer T, de Bree A. et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr 1997; 66 (05) 1232-1239
  • 2 Prakash V, Parameswaran N, Biswal N. Early versus late enteral feeding in critically ill children: a randomized controlled trial. Intensive Care Med 2016; 42 (03) 481-482
  • 3 Mikhailov TA, Kuhn EM, Manzi J. et al. Early enteral nutrition is associated with lower mortality in critically ill children. JPEN J Parenter Enteral Nutr 2014; 38 (04) 459-466
  • 4 Haney A, Burritt E, Babbitt CJ. The impact of early enteral nutrition on pediatric acute respiratory failure. Clin Nutr ESPEN 2018; 26: 42-46
  • 5 Méndez D, Rueda D. Evolution of enteral nutrition therapy: literature review. Conciencia Digital 2020; 3 (01) 264-283
  • 6 Arroyo A, Aguilar P, Obando R, Sifuentes C, Vrhuc C, Ávila M. Nutritional screening and its relationship with the results at hospital discharge. Rev. Soc. Peru . Med Interna 2015; 28 (04) 158-165 Accessed June 12, 2021 at: http://medicinainterna.net.pe/images/REVISTAS/2015/revista_28_4_2015/3_articulo_original.pdf
  • 7 McCarthy A, Delvin E, Marcil V. et al. Prevalence of malnutrition in pediatric hospitals in developed and in-transition countries: the impact of hospital practices. Nutrients 2019; 11 (02) 236
  • 8 Moore FA, Feliciano DV, Andrassy RJ. et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992; 216 (02) 172-183
  • 9 Keehn A, O'Brien C, Mazurak V. et al. Epidemiology of interruptions to nutrition support in critically ill children in the pediatric intensive care unit. JPEN J Parenter Enteral Nutr 2015; 39 (02) 211-217
  • 10 Tume LN, Valla FV, Joosten K. et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med 2020; 46 (03) 411-425
  • 11 Mehta NM, McAleer D, Hamilton S. et al. Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit. JPEN J Parenter Enteral Nutr 2010; 34 (01) 38-45 . Accessed June 19, 2021 at: https://pubmed.ncbi.nlm.nih.gov/19903872/
  • 12 Balakrishnan B, Flynn-O'Brien KT, Simpson PM, Dasgupta M, Hanson SJ. enteral nutrition initiation in children admitted to pediatric intensive care units after traumatic brain injury. Neurocrit Care 2019; 30 (01) 193-200 . Accessed July 02, 2021 at: https://link.springer.com/article/10.1007%2Fs12028-018-0597-6
  • 13 Srinivasan V, Hasbani NR, Mehta NM. et al; Heart and Lung Failure-Pediatric Insulin Titration (HALF-PINT) Study Investigators. Early enteral nutrition is associated with improved clinical outcomes in critically ill children: a secondary analysis of nutrition support in the heart and lung failure-pediatric insulin titration trial. Pediatr Crit Care Med 2020; 21 (03) 213-221
  • 14 Wong JJ, Han WM, Sultana R, Loh TF, Lee JH. Nutrition delivery affects outcomes in pediatric acute respiratory distress syndrome. JPEN J Parenter Enteral Nutr 2017; 41 (06) 1007-1013 . Accessed June 12, 2021 at: https://pubmed.ncbi.nlm.nih.gov/26962064/
  • 15 Agus MS, Hirshberg E, Srinivasan V. et al. Design and rationale of Heart and Lung Failure—Pediatric Insulin Titration Trial (HALF-PINT): a randomized clinical trial of tight glycemic control in hyperglycemic critically ill children. Contemp Clin Trials 2017; 53: 178-187
  • 16 Peev MP, Yeh DD, Quraishi SA. et al. Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. JPEN J Parenter Enteral Nutr 2015; 39 (01) 21-27 . Accessed June 23, 2021 at: https://pubmed.ncbi.nlm.nih.gov/24714361/
  • 17 Correia MITD, Perman MI, Pradelli L, Omaralsaleh AJ, Waitzberg DL. Economic burden of hospital malnutrition and the cost-benefit of supplemental parenteral nutrition in critically ill patients in Latin America. J Med Econ 2018; 21 (11) 1047-1056 . Accessed June 13, 2021 at: https://pubmed.ncbi.nlm.nih.gov/30001667/
  • 18 Waitzberg DL, Ravacci GR, Raslan M. Desnutrición hospitalaria. Nutr Hosp 2011; 26 (02) 254-264 . Accessed June 04, 2021 at: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112011000200003
  • 19 Tume LN, Eveleens RD, Verbruggen SCAT, Harrison G, Latour JM, Valla FV. ESPNIC Metabolism, Endocrine and Nutrition section. Barriers to delivery of enteral nutrition in pediatric intensive care: a world survey. Pediatr Crit Care Med 2020; 21 (09) e661-e671 . Accessed June 13, 2021 at: https://journals.lww.com/pccmjournal/Abstract/2020/09000/Barriers_to_Delivery_of_Enteral_Nutrition_in.32.aspx