Intermittent versus continuous enteral nutrition in critically ill children: A pre-planned secondary analysis of an international prospective cohort study

Abstract

Background & aims: Intermittent enteral nutrition (EN) may have physiologic benefits over continuous feeding in critical illness. We aimed to compare nutrition and infection outcomes in critically ill children receiving intermittent or continuous EN.

Methods: International, multi-center prospective observational study of mechanically ventilated children, 1 month to 18 years of age, receiving EN. Percent energy or protein adequacy (energy or protein delivered/prescribed × 100) and acquired infection rates were compared between intermittent and continuous EN groups using adjusted-multivariable and 4:1 propensity-score matched (PSM) analyses. Sensitivity analyses were performed after excluding patients who crossed over between intermittent and continuous EN.

Results: 1375 eligible patients from 66 PICUs were included. Patients receiving continuous EN (N = 1093) had a higher prevalence of respiratory illness and obesity, and lower prevalence of neurologic illness and underweight status on admission, compared to those on intermittent EN (N = 282). Percent energy or protein adequacy, proportion of patients who achieved 60% of energy or protein adequacy in the first 7 days of admission, and rates of acquired infection were not different between the 2 groups in adjusted-multivariable and propensity score matching analyses (P > 0.05).

Conclusion: Intermittent versus continuous EN strategy is not associated with differences in energy or protein adequacy, or acquired infections, in mechanically ventilated, critically ill children. Until further evidence is available, an individualized feeding strategy rather than a universal approach may be appropriate.

Keywords: Continuous; Enteral nutrition; Intermittent; Outcomes; Pediatric intensive care unit.

Figure 1. Time to achieve 60% of energy and protein via EN between patients who were continuous versus intermittent fed.

Each figure represents the percent of continuously (blue line) and intermittently (red line) fed patients who achieved 60% of energy adequacy (delivered/prescribed energy) for Panel A and 60% of protein adequacy (delivered/prescribed protein) for Panel B over time in the first 7 days of admission after adjusting for age, sex, admission type, diagnoses, nutritional status by BMI category, illness severity, comorbidities and use of feeding algorithm and censoring for death or transfer out of the intensive care unit. There was no difference (energy log-rank test p=0.231 and protein log-rank test p=0.744) in the percent of intermittently or continuously fed patients who achieved 60% of either energy of protein adequacy over the first 7 days of admission. EN, enteral nutrition; PICU, pediatric intensive care unit