Nutrition Delivery During Pediatric Extracorporeal Membrane Oxygenation Therapy.
BACKGROUND
Macronutrient delivery during pediatric ECMO therapy can be challenging. We examined predictors of nutrient delivery in the first 2 weeks of extracorporeal membrane oxygenation (ECMO) therapy in the pediatric intensive care unit (ICU).


METHODS
Details of macronutrient delivery were recorded in children (newborn-18 years of age) who survived 24 hours after cannulation to ECMO over a 3-year period (2012-2015).


RESULTS
We analyzed data from 54 consecutive eligible patients, 43% female, with median (interquartile range) ECMO duration of 8.5 (6-24) days, age 0.1 (0, 16) months, ICU length of stay 32 (21, 60) days, and 28-day mortality 13%. Median weight for age z score declined from -0.1 at admission to -1.2 at 30 days (P = 0.013). At least 80% goal energy and protein was delivered in 35 (65%) and 33 (61%) patients, respectively, by day 7; 10% of energy and 11% protein goal was delivered enterally. Parenteral nutrition (PN) was utilized in 47 (87%) patients, initiated by day 1 (1, 3). Enteral nutrition (EN) was successfully delivered in 49 (94%) patients (35% postpyloric), initiated by day 6 (2, 16). Younger age (P = 0.01) and venoarterial mode of ECMO (P = 0.0014) were associated with lower EN delivery. Use of umbilical artery catheters or vasoactive infusions did not impede EN delivery. Late PN delivery was associated with cumulative protein deficits (P = 0.019) and failure to achieve nutrient delivery goals by day 7.


CONCLUSIONS
Optimal nutrient delivery was achieved in most patients by day 7, predominantly via PN. Early EN is feasible in low volumes, but PN may be essential to prevent cumulative energy and protein deficits during the first week of ECMO.
['Armstrong|Lindsey B|LB|', 'Ariagno|Katelyn|K|', 'Smallwood|Craig D|CD|', 'Hong|Charles|C|', 'Arbuthnot|Mary|M|', 'Mehta|Nilesh M|NM|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D016638:Critical Illness D002149:Energy Intake D004750:Enteral Nutrition D015199:Extracorporeal Membrane Oxygenation D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D015278:Intensive Care Units, Pediatric D008297:Male D000078622:Nutrients D009751:Nutritional Requirements D009752:Nutritional Status D010288:Parenteral Nutrition D011502:Protein-Energy Malnutrition D011506:Proteins D013997:Time Factors D015431:Weight Loss
extracorporeal membrane oxygenation pediatric intensive care parenteral nutrition enteral nutrition congenital diaphragmatic hernia critically ill