Slain Katherine N, Martinez-Schlurmann Natalia, Shein Steven L, Stormorken Anne
Rainbow Babies & Children's Hospital, Cleveland, Ohio; and
Children's Hospital of Georgia, Augusta, Georgia.
Hosp Pediatr. 2017 May;7(5):256-262. doi: 10.1542/hpeds.2016-0194.
No guidelines are available regarding initiation of enteral nutrition in children with bronchiolitis on high-flow nasal cannula (HFNC) support. We hypothesized that the incidence of feeding-related adverse events (AEs) would not be associated with HFNC support.
This retrospective study included children ≤24 months old with bronchiolitis receiving HFNC in a PICU from September 2013 through April 2014. Data included demographics, respiratory support during feeding, and feeding-related AEs. Feeding-related AEs were extracted from nursing documentation and defined as respiratory distress or emesis. Feed route and maximum HFNC delivery were recorded in 8-hour shifts (6 am-2 pm, 2 pm-10 pm, and 10 pm-6 am).
70 children were included, with a median age of 5 (interquartile range [IQR] 2-10) months. HFNC delivery at feed initiation varied widely, and AEs related to feeding occurred rarely. Children were fed in 501 of 794 (63%) of nursing shifts, with AEs documented in only 29 of 501 (5.8%) of those shifts. The incidence of AEs at varying levels of respiratory support did not differ ( = .092). Children in the "early feeding" (fed within first 2 shifts) group ( = 22) had a shorter PICU length of stay (2.2 days [IQR 1.4-3.9] vs 3.2 [IQR 2.5-5.3], = .006) and shorter duration of HFNC use (26.0 hours [IQR 15.8-57.0] vs 53.5 [IQR 37.0-84.8], = .002), compared with children in the "late feeding" group ( = 48).
In this small, single-institution patient cohort, feeding-related AEs were rare and not related to the delivered level of respiratory support.
目前尚无关于毛细支气管炎患儿在接受高流量鼻导管（HFNC）支持时开始肠内营养的指南。我们假设与喂养相关的不良事件（AE）发生率与HFNC支持无关。
这项回顾性研究纳入了2013年9月至2014年4月在儿科重症监护病房（PICU）接受HFNC治疗的24个月及以下的毛细支气管炎患儿。数据包括人口统计学信息、喂养期间的呼吸支持以及与喂养相关的AE。与喂养相关的AE从护理记录中提取，定义为呼吸窘迫或呕吐。喂养途径和最大HFNC输送量按8小时轮班记录（上午6点至下午2点、下午2点至晚上10点和晚上10点至上午6点）。
共纳入70名儿童，中位年龄为5（四分位间距[IQR]2 - 10）个月。开始喂养时的HFNC输送量差异很大，与喂养相关的AE很少发生。在794个护理轮班中的501个（63%）轮班中对儿童进行了喂养，其中只有501个轮班中的29个（5.8%）记录了AE。不同呼吸支持水平下AE的发生率无差异（P = 0.092）。与“延迟喂养”组（n = 48）相比，“早期喂养”（在前2个轮班内喂养）组（n = 22）的患儿在PICU的住院时间更短（2.2天[IQR 1.4 - 3.9] vs 3.2天[IQR 2.5 - 5.3]，P = 0.006），HFNC使用时间更短（26.0小时[IQR 15.8 - 57.0] vs 53.5小时[IQR 37.0 - 84.8]，P = 0.002）。
在这个小型的单机构患者队列中，与喂养相关的AE很少见，且与呼吸支持的输送水平无关。
