Enteral feeding in pediatric patients with bronchiolitis requiring non-invasive support via nasal interface.

Abstract

Background and objectives: The benefits of enteral feeding in critically ill children have been well described, but the use of non-invasive respiratory support has been shown to delay initiation of feeds, in part due to safety concerns. We aimed to examine the association of enteral feeding by mouth and orogastric tube on clinically significant adverse events in children with bronchiolitis being treated with non-invasive respiratory support via nasal interfaces.

Methods: A retrospective cohort study of patients 0-24 months of age between 2016 and 2022 in a quaternary care hospital pediatric intensive care unit with a diagnosis of bronchiolitis and treatment with non-invasive respiratory support via nasal interface. Standard comparative statistics and multivariable regression were used to determine the association between oral and nasogastric feeding and clinically significant outcomes such as new diagnosis of pneumonia and escalation in respiratory support, as well lengths of stay.

Results: There were 407 patients 24 months or younger who were admitted with bronchiolitis and treated with non-invasive respiratory support. There was a 4.65 increased odds of developing a new pneumonia for patients who were fed nasogastrically versus orally. There were no differences in the development of pneumonia based on type of respiratory support, whether an escalation in respiratory support was needed, or based on the highest level of support received. Both pediatric intensive care unit and overall hospital lengths of stay were decreased in those who were orally fed.

Conclusions: Enteral feeding in children with bronchiolitis receiving non-invasive respiratory support appears to be safe and not associated with escalation in support or new diagnoses of pneumonia. Oral feeds were associated with decreased lengths of stay. Further work is needed to assess long term safety and ability to achieve adequate nutritional requirements.

Impact: Enteral feeding of children with bronchiolitis requiring non-invasive respiratory support via nasal interfaces did not have an effect on clinically significant adverse events Feeding by mouth led to decreased risk of pneumonia and shorter inpatient length of stay Future work is needed to study the ability to achieve nutrition goals when feeding by mouth on non-invasive support.