Prevalence of Feeding Intolerance in PICU: A Cross-sectional Study

Document Type : Research Paper

Authors

1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Malnutrition, as defined by the World Health Organization (WHO), occurs when the body does not receive sufficient nutrients or energy to meet growth, maintenance, and functional needs. Severe malnutrition in children increases the risk of death, disease episodes, complications, and prolonged illnesses. Therefore, early nutritional support is crucial in pediatric critical care settings. In cases where oral feeding is not feasible, enteral feeding (EN) becomes necessary to provide adequate energy. However, despite its advantages, feeding intolerance remains a significant challenge. This study aims to determine the prevalence of feeding intolerance among critically ill children in the Pediatric Intensive Care Unit (PICU). Method: This cross-sectional study was conducted at the Akbar Pediatric Subspecialty Center's PICU in Mashhad, Iran between March and April 2022. The evaluation focused on nutritional adequacy and feeding intolerance. Results: A total of 72 patients were included in this study with a majority being girls. Approximately 30 percent of patients exhibited severe malnutrition based on their BMI Z-score (<-3). Boys were more affected than girls in this regard. Most patients received a combination of EN and parenteral nutrition (PN) to fulfill their energy and protein requirements successfully. In most cases, children consumed over 66% of their energy needs through these methods. Feeding intolerance primarily manifested as vomiting and regurgitation (47%), followed by high gastric residual volume (GRV) (36.1%) and abdominal distention (34.7%). Conclusion: The findings from our study highlight the prevalence of malnutrition within PICU settings along with common complications associated with feeding intolerance such as vomiting and regurgitation. Standardizing a definition for feeding intolerance could prove beneficial for improving research protocols aimed at effectively managing this condition.

Keywords

Main Subjects

References

  1. Yu K, Guo N, Zhang D, Xia Y, Meng Y, Weng L, Du B. Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study. Chinese Medical Journal. 2022;135(15):1814-20.
  2. Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiologica Scandinavica. 2009;53(3):318-24.
  3. Kratochvíl M, Klučka J, Klabusayová E, Musilová T, Vafek V, Skříšovská T, et al. Nutrition in Pediatric Intensive Care: A Narrative Review. Children. 2022;9(7):1031.
  4. Kesari A, Noel JY. Nutritional Assessment. StatPearls [Internet]: StatPearls Publishing. 2022.
  5. Tume LN, Valla FV, Joosten K, Jotterand Chaparro C, Latten L, Marino LV, et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Medicine. 2020;46:411-25.
  6. Yahyapoor F, Dehnavi Z, Askari G, Ranjbar G, Zarifi SH, Bagherniya M, et al. The prevalence and possible causes of enteral tube feeding intolerance in critically ill patients: A cross-sectional study. Journal of Research in Medical Sciences. 2021;26.
  7. Blaser AR, Starkopf J, Kirsimägi Ü, Deane AM. Definition, prevalence, and outcome of feeding intolerance in intensive care: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2014;58(8):914-22.
  8. Reintam A, Parm P, Kitus R, Starkopf J, Kern H. Gastrointestinal failure score in critically ill patients: a prospective observational study. Critical Care. 2008;12:1-8.
  9. Wang K, McIlroy K, Plank LD, Petrov MS, Windsor JA. Prevalence, outcomes, and management of enteral tube feeding intolerance: a retrospective cohort study in a tertiary center. Journal of Parenteral and Enteral Nutrition. 2017;41(6):959-67.
  10. Reintam Blaser A, Deane AM, Preiser JC, Arabi YM, Jakob SM. Enteral feeding intolerance: updates in definitions and pathophysiology. Nutrition in Clinical Practice. 2021;36(1):40-9.
  11. Brown A-M, Carpenter D, Keller G, Morgan S, Irving SY. Enteral nutrition in the PICU: current status and ongoing challenges. Journal of Pediatric Intensive Care. 2015;4(02):111-20.
  12. Tume LN, Valla FV. A review of feeding intolerance in critically ill children. European Journal of Pediatrics. 2018;177:1675-83.
  13. Tume LN, Arch B, Woolfall K, Latten L, Deja E, Roper L, et al. Gastric residual volume measurement in UK paediatric intensive care units: a survey of practice. Pediatric Critical Care Medicine. 2019;20(8):707.
  14. Liauchonak S, Hamilton S, Franks JD, Callif C, Akhondi‐Asl A, Ariagno K, et al. Impact of implementing an evidence‐based definition of enteral nutrition intolerance on nutrition delivery: A prospective, cross‐sectional cohort study. Nutrition in Clinical Practice. 2023;38(2):376-85.
  15. Solana MJ, Slocker M, Martínez de Compañon Z, Olmedilla M, Miñambres M, Reyes S, et al. Prevalence, Risk Factors and Impact of Nutrition Interruptions in Critically Ill Children. Nutrients. 2023;15(4):855.
  16. Lee JO, Gauglitz GG, Herndon DN, Hawkins HK, Halder SC, Jeschke MG. Association between dietary fat content and outcomes in pediatric burn patients. Journal of Surgical Research. 2011 Mar 1;166(1):e83-90.
Journal of Nutrition,Fasting and Health
Volume 12, Issue 1
March 2024
Pages 1-6

Files

History

  • Receive Date: 30 April 2023
  • Revise Date: 09 September 2023
  • Accept Date: 10 September 2023

Share

How to cite

Statistics