Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

• Published in: European journal of clinical nutrition 2008-03, Vol.62 (3), p.395-400
• Main Authors: López-Herce, J, Santiago, M.J, Sanchez, C, Mencia, S, Carrillo, A, Vigil, D
• Format: Article
• Language: English
• Subjects: acute course; Acute Kidney Injury - complications; Adolescent; Adult; Biological and medical sciences; Child; child nutrition; Child, Preschool; Children; Children & youth; Clinical Nutrition; complications; Critical Illness - mortality; Critical Illness - therapy; Critically ill children; Diarrhea; Distension; Dopamine; Enteral feeding; Enteral nutrition; Enteral Nutrition - adverse effects; Enterocolitis; Epidemiology; Epinephrine; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastrointestinal diseases; Gastrointestinal Diseases - epidemiology; Gastrointestinal Diseases - etiology; Gastrointestinal Diseases - mortality; gastrointestinal system; Humans; Hypokalemia; Hypokalemia - complications; Hypophosphatemia; Hypophosphatemia - complications; hypovolemic shock; Infant; Infant, Newborn; Internal Medicine; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Multivariate analysis; Necrosis; Necrotizing enterocolitis; Nutrition; Nutrition research; Nutritional aspects; Observational studies; original-article; Patients; Pediatrics; Physical growth; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - mortality; Prospective Studies; Public Health; Pylorus; Regression analysis; Renal failure; Risk analysis; Risk Factors; Shock - complications; Time Factors; transpyloric enteral nutrition; Treatment Outcome; Tube feeding; vecuronium; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/sj.ejcn.1602710

Objective: To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children. Design: A prospective, observational study. Setting: Pediatric intensive care unit Subjects: Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN). Methods: Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications. Results: Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 g/kg/min and hypophosphatemia. Conclusions: The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.