Substandard feeding in children undergoing mechanical ventilation in pediatric intensive care unit: A retrospective cohort study in China
PDF
XML

Keywords

China
enteral nutrition
retrospective studies
intensive care units
feeding
pediatric
risk factors
nursing care
incidence
child

How to Cite

Li, M., Wang, Y., & Chen, Q. (2023). Substandard feeding in children undergoing mechanical ventilation in pediatric intensive care unit: A retrospective cohort study in China. Belitung Nursing Journal, 9(6), 580–585. https://doi.org/10.33546/bnj.2876
Crossref
Scopus
Google Scholar

Link to Google Scholar

Accepted for publication: 2023-11-03
Peer reviewed: Yes

Related articles in


Search Relations - Article by Author(s)

Share this article on:

Abstract

Background: Enteral nutrition is a common yet vital practice in the pediatric intensive care unit (PICU). However, the status of substandard feeding of enteral nutrition in PICU children undergoing mechanical ventilation remains unclear and can be detrimental to the children’s prognosis.

Objective: This study aimed to evaluate the incidence, nursing care status, and influencing factors of substandard feeding in children undergoing mechanical ventilation in the PICU.

Methods: This study employed a retrospective cohort design. Children undergoing mechanical ventilation and enteral nutrition in the PICU of a public hospital in China from 1 June 2021 to 31 December 2022 were selected using convenience sampling, and their characteristics were collected and evaluated. Pearson correlation analysis and multivariate logistic regression analysis were conducted to assess the influencing factors of substandard feeding in PICU children with mechanical ventilation.

Results: A total of 156 PICU children undergoing mechanical ventilation were included for analysis in this study. The rate of substandard feeding in PICU children was 65.38%. Statistically significant differences were observed in diarrhea, vomiting, the use of sedatives, and average infusion speed between the substandard feeding group and the standard group (p <0.05). Pearson correlation results indicated that diarrhea (r = 0.595), vomiting (r = 0.602), and average infusion speed (r = 0.562) were correlated with substandard feeding and characteristics of included ICU children undergoing mechanical ventilation (p <0.05). Logistic regression results found that diarrhea (OR = 2.183, 95%CI: 1.855~2.742), vomiting (OR = 3.021, 95%CI: 2.256~4.294), and average infusion speed ≤40 mL/h (OR = 2.605, 95%CI: 1.921~3.357) were independent risk factors for substandard feeding in mechanically ventilated children in the ICU (p <0.05).

Conclusion: The rate of substandard feeding in children with mechanical ventilation in the PICU was high. Diarrhea, vomiting, and slow infusion speed are important influencing factors for substandard feeding. It is suggested that nurses and other healthcare professionals take targeted measures, including the prevention and care of diarrhea and vomiting, as well as monitoring and adjusting the infusion speed of enteral nutrition, to reduce the occurrence of substandard feeding.

https://doi.org/10.33546/bnj.2876
PDF
XML

Copyright

Copyright (c) 2023 Meng Li, Ying Wang, Qingxiu Chen

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Article Metrics

Total views 102 [Abstract: 35 | PDF: 67 | XML: 0 ]

Downloads

Download data is not yet available.

PlumX Metrics

Declaration of Conflicting Interest

The authors declare that they have no conflicting interests in this study.

Funding

None.

Acknowledgment

None.

Authors’ Contributions

ML and YW contributed equally to designing and conducting research, analyzing data, and writing the first draft of the manuscript. QC contributed to conducting research and was primarily responsible for the final content. All authors read and approved the final manuscript and were accountable for each step of the study.

Data Availability

The datasets generated during and analyzed during the current study are available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

Nothing to declare.


References

Abukari, A. S., & Acheampong, A. K. (2021). Feeding the critically ill child in intensive care units: A descriptive qualitative study in two tertiary hospitals in Ghana. BMC Pediatrics, 21, 395. https://doi.org/10.1186/s12887-021-02854-2

Bagci, S., Keleş, E., Girgin, F., Yıldızdaş, D. R., Horoz, Ö. Ö., Yalındağ, N., Tanyıldız, M., Bayrakçi, B., Kalkan, G., & Akyıldız, B. N. (2018). Early initiated feeding versus early reached target enteral nutrition in critically ill children: An observational study in paediatric intensive care units in Turkey. Journal of Paediatrics and Child Health, 54(5), 480-486. https://doi.org/10.1111/jpc.13810

BaiNu, W., Huibin, P., & Peipei, H. (2018). Effect of standardized treatment of enteral nutrition complicated with gastric retention on feeding standard rate of critically ill patients [in Chinese]. Chinese Journal of Nursing, 53(12).

Bixia, L., Lichun, X., & Yiduan, Y. (2019). Evidence summary of symptom management of feeding intolerance in patients with severe nasal feeding [in Chinese]. Nursing Management in China, 19(2), 7-10.

Brierley-Hobson, S., Clarke, G., & O’Keeffe, V. (2019). Safety and efficacy of volume-based feeding in critically ill, mechanically ventilated adults using the ‘Protein & Energy Requirements Fed for Every Critically ill patient every Time’(PERFECT) protocol: A before-and-after study. Critical Care, 23, 105. https://doi.org/10.1186/s13054-019-2388-7

Brown, A.-M., Carpenter, D., Keller, G., Morgan, S., & Irving, S. Y. (2015). Enteral nutrition in the PICU: Current status and ongoing challenges. Journal of Pediatric Intensive Care, 4(02), 111-120. https://doi.org/10.1055/s-0035-1559806

Chen, L., Zheng, S., Xie, Q., Huang, L., & Yin, G. (2022). The effect of different nutritional nursing support on the nutritional status and disease recovery of elderly patients with gastrointestinal tumors during the perioperative period. Computational and Mathematical Methods in Medicine, 2022, 4977922. https://doi.org/10.1155/2022/4977922

Du, N., Cui, Y., Xie, W., Yin, C., Gong, C., & Chen, X. (2021). Application effect of initiation of enteral nutrition at different time periods after surgery in neonates with complex congenital heart disease: A retrospective analysis. Medicine, 100(1), e24149. https://doi.org/10.1097%2FMD.0000000000024149

Elke, G., Felbinger, T. W., & Heyland, D. K. (2015). Gastric residual volume in critically ill patients: A dead marker or still alive? Nutrition in Clinical Practice, 30(1), 59-71. https://doi.org/10.1177/0884533614562841

Elke, G., van Zanten, A. R. H., Lemieux, M., McCall, M., Jeejeebhoy, K. N., Kott, M., Jiang, X., Day, A. G., & Heyland, D. K. (2016). Enteral versus parenteral nutrition in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials. Critical Care, 20, 117. https://doi.org/10.1186/s13054-016-1298-1

Feiyue, L., Yin, Q., & Fei, L. (2023). Substandard feeding status and influencing factors of mechanically ventilated patients in intensive care unit [in Chinese]. Chinese Journal of Practical Nursing, 39(2), 151-156.

Jing, L., Xiaojin, L., & Lirong, C. (2022). Risk factors and preventive nursing of enteral nutrition intolerance in children with mechanical ventilation in children intensive care unit [in Chinese]. General Nursing, 20(17), 6-9.

Kalaiselvan, M. S., Arunkumar, A. S., Renuka, M. K., & Sivakumar, R. L. (2021). Nutritional adequacy in mechanically ventilated patient: Are we doing enough? Indian Journal of Critical Care Medicine, 25(2), 166-171. https://doi.org/10.5005%2Fjp-journals-10071-23717

Kayastha, P., Shrestha, S., & Subba, A. (2022). Feeding intolerance among preterm neonates admitted to the neonatal intensive care unit at a tertiary care centre: A descriptive cross-sectional study. Journal of the Nepal Medical Association, 60(255), 952-954. https://doi.org/10.31729%2Fjnma.8126

Kerklaan, D., Fivez, T., Mehta, N. M., Mesotten, D., van Rosmalen, J., Hulst, J. M., Van den Berghe, G., Joosten, K. F. M., & Verbruggen, S. C. A. T. (2016). Worldwide survey of nutritional practices in PICUs. Pediatric Critical Care Medicine, 17(1), 10-18. https://doi.org/10.1097/PCC.0000000000000542

Kunrong, Y., Mei, L., & Yue, W. (2019). Meta analysis of the effect of unconventional monitoring of gastric residue on feeding complications and calorie intake in critically ill patients with continuous enteral nutrition [in Chinese]. Chinese Journal of Practical Nursing, 35(30), 2395-2401.

Lee, Z.-Y., Airini, I. N., & Barakatun-Nisak, M.-Y. (2018). Relationship of energy and protein adequacy with 60-day mortality in mechanically ventilated critically ill patients: A prospective observational study. Clinical Nutrition, 37(4), 1264-1270. https://doi.org/10.1016/j.clnu.2017.05.013

Li, C., Hui, Y., & Jufang, L. (2021). Summary of the best evidence for prevention and management of enteral nutrition-related complications [in Chinese]. Parenteral and Parenteral Nutrition, 28(2), 109-116.

Marino, L. V., Johnson, M. J., & Beattie, R. M. (2020). Feeding intolerance in children with critical illness. Clinical Nutrition, 39(3), 609-611. https://doi.org/10.1016/j.clnu.2019.04.005

Minmin, L., Zaixia, S., & Jin, L. (2020). Summary of the best evidence for prevention and management of feeding intolerance in premature infants [in Chinese]. Chinese Journal of Nursing, 55(8), 6-9.

Ortiz-Reyes, L., Patel, J. J., Jiang, X., Coz Yataco, A., Day, A. G., Shah, F., Zelten, J., Tamae-Kakazu, M., Rice, T., & Heyland, D. K. (2022). Early versus delayed enteral nutrition in mechanically ventilated patients with circulatory shock: A nested cohort analysis of an international multicenter, pragmatic clinical trial. Critical Care, 26, 173. https://doi.org/10.1186/s13054-022-04047-4

Padar, M., Starkopf, J., Starkopf, L., Forbes, A., Hiesmayr, M., Jakob, S. M., Rooijackers, O., Wernerman, J., Ojavee, S. E., & Blaser, A. R. (2021). Enteral nutrition and dynamics of citrulline and intestinal fatty acid-binding protein in adult ICU patients. Clinical Nutrition ESPEN, 45, 322-332. https://doi.org/10.1016/j.clnesp.2021.07.026

Patel, J. J., Rice, T., & Heyland, D. K. (2020). Safety and outcomes of early enteral nutrition in circulatory shock. Journal of Parenteral and Enteral Nutrition, 44(5), 779-784. https://doi.org/10.1002/jpen.1793

Skillman, H. E., & Mehta, N. M. (2012). Nutrition therapy in the critically ill child. Current Opinion in Critical Care, 18(2), 192-198. https://doi.org/10.1097/MCC.0b013e3283514ba7

Skillman, H. E., & Wischmeyer, P. E. (2008). Nutrition therapy in critically ill infants and children. Journal of Parenteral and Enteral Nutrition, 32(5), 520-534. https://doi.org/10.1177/0148607108322398

Tension, X. Z., & Liang, Y. (2015). Early enteral nutrition and its influencing factors in patients with severe stroke [in Chinese]. Nursing Research, 26(10), 1175-1178.

Theodoridis, X., Chrysoula, L., Evripidou, K., Kalaitzopoulou, I., & Chourdakis, M. (2023). Continuous versus intermittent enteral feeding in critically ill children: A systematic review. Nutrients, 15(2), 288. https://doi.org/10.3390/nu15020288

Tian, F., Heighes, P. T., Allingstrup, M. J., & Doig, G. S. (2018). Early enteral nutrition provided within 24 hours of ICU admission: A meta-analysis of randomized controlled trials. Critical Care Medicine, 46(7), 1049-1056. https://doi.org/10.1097/CCM.0000000000003152

Wiese, A. N., Rogers, M. J. M., Way, M., & Ballard, E. (2020). The impact of removing gastric residual volume monitoring and enteral nutrition rate titration in adults receiving mechanical ventilation. Australian Critical Care, 33(2), 155-161. https://doi.org/10.1016/j.aucc.2018.12.001

Wong, J. J. M., Ong, C., Han, W. M., Mehta, N. M., & Lee, J. H. (2016). Survey of contemporary feeding practices in critically ill children in the Asia-Pacific and the Middle East. Asia Pacific Journal of Clinical Nutrition, 25(1), 118-125. https://doi.org/10.6133/apjcn.2016.25.1.07

Xingxia, L., Meiqi, Y., & Jinlan, Y. (2021). The incidence and influencing factors of refeeding syndrome in patients with enteral nutrition in ICU [in Chinese]. Chinese Journal of Nursing, 56(6), 818-823.

Xiuqin, F., Lingyun, C., & Jiajia, Z. (2021). Nursing care of 15 patients with extra severe burn in prone position with early post-pyloric feeding without deceleration [in Chinese]. Chinese Journal of Nursing, 56(6), 818-823.

Xuemei, G., Xianghong, Y., & Yan, W. (2019). Investigation on the interruption of early enteral nutrition in critically ill children [in Chinese]. Chinese Journal of Modern Nursing, 25(13), 1646-1650.

Yip, K. F., Rai, V., & Wong, K. K. (2014). Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients. BMC Anesthesiology, 14, 127. https://doi.org/10.1186/1471-2253-14-127

Yuanyuan, M., Peipei, H., & Jiang, D. (2019). Summary of the best evidence for prevention and management of enteral nutrition intolerance in critically ill patients [in Chinese]. Chinese Journal of Nursing, 54(12), 1868-1876.

Zaher, S. (2022). Barriers to delivery of enteral nutrition in intensive care settings in Saudi Arabia: A comparative study of the perceptions of health care providers working in adult and paediatric ICUs. Risk Management and Healthcare Policy, 2357-2370. https://doi.org/10.2147/RMHP.S394035

Zhang, W., Zhu, N.-N., Jiang, H.-J., Tao, X.-B., Lu, W.-H., Shen, H.-C., Wu, Y.-D., Li, K.-K., & Huo, R. (2021). Prevention of underfeeding during enteral nutrition after gastrectomy in adult patients with gastric cancer: An evidence utilization project. JBI Evidence Implementation, 19(2), 198-207. https://doi.org/10.1097%2FXEB.0000000000000248

Zhengying, J., Zhigang, C., & Weiqin, L. (2021). Expert consensus on enteral nutrition in critically ill patients with gastrointestinal dysfunction [in Chinese]. Chinese Journal of Digestive Surgery, 20(11), 1123-1136.


Readers are able to give us their valuable feedbacks here. The comments will be reviewed by the editors and then published here. Important Note: The "Comments" related to the Galley Proof PDF must NOT be submitted via this form. Authors should submit their comments on their galley proofs only via system