Abstract

More than 30% of children admitted to the Pediatric Intensive Care Unit (PICU) are malnourished and are at risk to develop new or worsened malnutrition during their hospitalization. Delivery of enteral nutrition (EN) during hospitalization is associated with lower mortality and morbidity rates. Barriers to adequate delivery of EN include hemodynamic instability, feeding interruptions, feeding intolerance and lack of standardized feeding protocols. Gastrointestinal (GI) dysmotility during critical illness increases the risk of feeding intolerance due to increased influence of the Sympathetic Nervous System. Critically ill children have traditionally been fed via continuous gastric infusion under the assumption that slow, continuous feeding decreases the risk of intolerance and aspiration. However, GI physiology suggests GI motility is enhanced when the gut is rested between feedings. The purpose of this comparative effectiveness study was to evaluate two enteral feeding delivery modes, continuous versus bolus, on the attainment of prescribed caloric and protein nutritional goals and the frequency and type of feeding intolerance events in mechanically ventilated infants and children 1 month corrected gestation age through 12 years of age. Twenty-five children were randomized to a bolus (n = 11) or continuous (n = 14) feeding group. Group characteristics were similar for demographics and severity of illness scores. Independent sample t-tests and Mixed Measures RM-ANOVA were used to test hypotheses. The bolus group attained higher energy (p = .001) and protein (p = .006) intake in the first 24 hours of feeds compared to the continuous group. The bolus group also attained goal feeds faster than the continuous group (median of 15 hours versus 29.5 hours, respectively). There were few interruptions or intolerance events recorded in either group. No relationship was identified between emesis, gastric residual volume or abdominal girth as intolerance measures. No aspiration pneumonitis diagnosis was recorded in either group. No difference was found in Oxygen Saturation Index scores between groups. Bolus feeds enhance delivery of target energy and protein intake with an equivalent safety profile to continuous feeding. Further study is needed to compare delivery modes in critically ill patients on the delivery of target energy and protein goals and incidence of adverse events.

Description

This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3671063; ProQuest document ID: 1645957733. The author still retains copyright.

Ann-Marie Brown

Author Details

Ann-Marie Brown, RN, PhD, CPNP-AC/PC, CCRN, FCCM

Sigma Membership

Delta Omega

Type

Dissertation

Format Type

Text-based Document

Study Design/Type

Randomized Controlled Trial

Research Approach

Pilot/Exploratory Study

Keywords:

Pediatric Patients, Tube Feeding, Enteral Feeding Methods

Advisors

Fisher, Elaine

Degree

PhD

Degree Grantor

The University of Akron

Degree Year

2014

Rights Holder

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All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2019-06-10

Full Text of Presentation

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