Ren Ye, Lu Siwei, Chen Yingfu, Sun Yuelin, Fu Yueqiang, Liu Chengjun, Li Jing, Dang Hongxing
Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
Front Pediatr. 2025 Mar 31;13:1505935. doi: 10.3389/fped.2025.1505935. eCollection 2025.
Malnutrition remains a significant issue in children undergoing ECMO. This study aimed to investigate the effects of initiating enteral nutrition (EN) within 24 h on the adequacy of nutrient intake, nutritional status, anabolic metabolism, and inflammatory markers in children receiving ECMO.
This was a prospective observational cohort study, including children receiving ECMO therapy at the Children's Hospital of Chongqing Medical University of China from April 2018 to August 2024. Patients were divided into early EN (EEN) and late EN (LEN) groups based on whether effective EN was initiated within 24 h after the start of ECMO. -tests or Mann-Whitney and Chi-square tests were used to compare the clinical characteristics, serum total protein (TP), nutritional intake, serum cholinesterase (CHE), and C-reactive protein (CRP) levels between the two groups. Linear mixed-effects models (LME) were applied to assess the effect of EEN on changes in CRP and CHE levels over time during ECMO.
A total of 47 children were included in this study, with 24 patients (51.1%) successfully receiving EEN. The PRISM3 score was higher in the LEN group ( = 0.016). The majority of children in the EEN group had pneumonia or ARDS ( < 0.001). The average daily energy and protein intake, as well as their adequacy, was higher in the EEN group compared to the LEN group ( < 0.001), although the EEN group experienced more frequent interruptions in EN ( < 0.05). Serum TP levels in the EEN group were higher than those in the LEN group during the first 3 days of ECMO ( < 0.05). The median CHE levels were higher, and the median CRP levels were lower in the EEN group compared to the LEN group ( < 0.05). LME analysis showed a significant interaction effect between EEN and time on CRP and CHE levels ( < 0.001).
Successfully initiating EN within 24 h significantly improves the nutritional status of children receiving ECMO, promotes hepatic anabolic metabolism, and reduces inflammatory responses. This study provided new insights and data support for nutritional therapy strategies in children on ECMO.
营养不良仍是接受体外膜肺氧合（ECMO）治疗的儿童中的一个重要问题。本研究旨在探讨在24小时内开始肠内营养（EN）对接受ECMO治疗的儿童营养摄入充足性、营养状况、合成代谢及炎症标志物的影响。
这是一项前瞻性观察性队列研究，纳入了2018年4月至2024年8月在中国重庆医科大学附属儿童医院接受ECMO治疗的儿童。根据在ECMO开始后24小时内是否开始有效的EN，将患者分为早期EN（EEN）组和晚期EN（LEN）组。采用t检验或Mann-Whitney U检验以及卡方检验比较两组的临床特征、血清总蛋白（TP）、营养摄入、血清胆碱酯酶（CHE）和C反应蛋白（CRP）水平。应用线性混合效应模型（LME）评估EEN对ECMO期间CRP和CHE水平随时间变化的影响。
本研究共纳入47例儿童，其中24例（51.1%）成功接受EEN。LEN组的PRISM3评分更高（P = 0.016）。EEN组的大多数儿童患有肺炎或急性呼吸窘迫综合征（ARDS）（P < 0.001）。与LEN组相比，EEN组的平均每日能量和蛋白质摄入量及其充足性更高（P < 0.001），尽管EEN组的EN中断更频繁（P < 0.05）。在ECMO的前3天，EEN组的血清TP水平高于LEN组（P < 0.05）。与LEN组相比，EEN组的CHE水平中位数更高，CRP水平中位数更低（P < 0.05）。LME分析显示EEN与时间对CRP和CHE水平有显著的交互作用（P < 0.001）。
在24小时内成功开始EN可显著改善接受ECMO治疗的儿童的营养状况，促进肝脏合成代谢，并减轻炎症反应。本研究为接受ECMO治疗的儿童的营养治疗策略提供了新的见解和数据支持。
