Factors that influence the provision of enteral feeding for critically ill children: a qualitative evidence synthesis.

Background: This review aims to explore factors associated with the provision of enteral nutrition in critically ill children in intensive care. Critically ill children are at risk of becoming malnourished, which can lead to poorer outcomes such as longer hospital stays, increased readmissions, and increased mortality. Optimal enteral feeding can help prevent and manage malnutrition.

Methods: We searched MEDLINE, CINAHL, Embase, and Scopus from inception to July 3, 2023. We included qualitative studies and mixed-methods studies. As we anticipated few studies in critical care settings, we included studies that focused on experiences and perceptions of any stakeholders involved in enteral feeding in children in any hospital setting to provide indirect evidence. Titles, abstracts and potentially eligible full-text records were independently assessed. We extracted descriptive data and used a thematic analysis approach to synthesise the study data. We used the GRADE-CERQual approach to assess our confidence in each finding.

Results: We included 14 studies, with four from critical care settings. Where we had concerns that the context of the studies may be less relevant to the setting, intervention and population of interest, we indicated this inour GRADE-CERQual assessment. We had moderate, low or very low confidence in our findings, in part due to the indirectness of the evidence. Moderate confidence findings indicated that parents were concerned about discomfort and side effects, and that a lack of resources could be a barrier to providing optimal nutritional support. Low confidence findings suggested that healthcare workers lacked the knowledge and skills to provide adequate nutritional support, and that receiving support, information, and participating in decision-making around enteral feeding was important to some parents.

Conclusions: Our review points to several factors that may influence the provision of enteral feeding for critically ill children. More qualitative research on healthcare workers' nutritional support practices, particularly in critical care settings, is needed to provide a better understanding of the barriers to optimal enteral feeding in critically ill children.