Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón.
Gregorio Marañón Health Research Institute (IISGM).
J Pediatr Gastroenterol Nutr. 2022 Jan 1;74(1):110-115. doi: 10.1097/MPG.0000000000003317.
To assess the safety of enteral nutrition (EN) in children on extracorporeal membrane oxygenation (ECMO). To describe nutritional status and the characteristics of the nutritional support in this population.
A retrospective single-center analysis (2006-2016) including children <18 years on ECMO. Demographic data, nutritional status, characteristics of nutritional support, and development of gastrointestinal (GI) complications were recorded.
One hundred children, with a median age of 9.7 months (interquartile range [IQR] 3.9-63.1) were enrolled. Undernutrition was prevalent among children on ECMO (33.3%) mainly in patients <2 years (P = 0.042). Most patients (64%) received EN at some point during ECMO therapy. EN was administered in the first 48 hours after ECMO initiation (48HEN) to 60.3% of the children.Mortality rate in the Pediatric Intensive Care Unit was lower in patients who received EN as the initial artificial nutrition support (ANS) (37.7 vs 51%, P = 0.005) and in children on 48HEN (34% vs 50%, P = 0.04). In the logistic regression analysis, duration of ECMO support and low cardiac output indication were the only factors associated with mortality.Although most patients on ECMO (45%) developed digestive complications, they were mostly mild, being constipation the most prevalent. In the logistic regression analysis, EN was not associated with an increase in GI complications (P = 0.09). Only three patients developed intestinal ischemia (one without EN and two on EN).
Undernutrition is prevalent among children on ECMO, mainly in infants <2 years. EN is not associated with severe gastrointestinal complications or higher mortality in these children.
评估体外膜肺氧合（ECMO）患儿肠内营养（EN）的安全性。描述该人群的营养状况和营养支持特点。
回顾性单中心分析（2006-2016 年）纳入 ECMO 治疗的<18 岁儿童。记录人口统计学数据、营养状况、营养支持特点以及胃肠道（GI）并发症的发生情况。
共纳入 100 例儿童，中位年龄为 9.7 个月（四分位距 [IQR] 3.9-63.1）。ECMO 患儿普遍存在营养不良（33.3%），主要发生在<2 岁的患儿中（P=0.042）。大多数患儿（64%）在 ECMO 治疗期间接受过 EN。60.3%的患儿在 ECMO 启动后 48 小时内（48HEN）开始给予 EN。在儿科重症监护病房（PICU）中，接受 EN 作为初始人工营养支持（ANS）的患儿死亡率较低（37.7% vs 51%，P=0.005），接受 48HEN 的患儿死亡率较低（34% vs 50%，P=0.04）。在逻辑回归分析中，ECMO 支持时间和低心输出量是与死亡率相关的唯一因素。尽管大多数 ECMO 患儿（45%）发生了消化并发症，但大多为轻度，其中便秘最常见。在逻辑回归分析中，EN 与 GI 并发症的增加无关（P=0.09）。仅 3 例患儿发生肠缺血（1 例无 EN，2 例有 EN）。
ECMO 患儿普遍存在营养不良，主要发生在<2 岁的婴儿中。EN 与这些患儿的严重胃肠道并发症或更高死亡率无关。
