Association between enteral feeding and gastrointestinal complications in children receiving extracorporeal life support: A retrospective cohort study.

BACKGROUND: Extracorporeal life support is an accepted treatment modality for children with severe cardiac and/or respiratory dysfunction. However, after a period of inadequate gut perfusion clinicians are often reluctant to initiate enteral nutrition.

METHODS: A retrospective cohort study in a single large pediatric intensive care unit in Northwest England over 5.5 years (2017 - 2022).

RESULTS: 156 children were included with a median age of two months (IQR 0.3 - 15) and a mean weight for age score of -1.50 (SD 1.7). Indications for extracorporeal life support were respiratory failure (31%); cardiac arrest (28%); low cardiac output state (27%) and unable to separate from cardiopulmonary bypass (12%). Most (75%) children were fed during extracorporeal life support, with the median time to initiate feeding 24 hours (IQR 12.2 - 42.7). More Gastrointestinal complications were associated with being enterally fed 86% vs 14% (p=<0.001), but these were predominantly feed intolerance (46%), and this was associated with receiving formula feeds compared to maternal (breast) milk (p=<0.001). Overall children's median energy target achievement by 72 hours was 38% (IQR 10.7 -76%) but this varied by support indication.

CONCLUSIONS: Our findings suggest most children tolerated enteral feeding within 24 hours after extracorporeal life support initiation, with only mild gastrointestinal complications. This article is protected by copyright. All rights reserved.