Enteral Nutrition Practices during Non-invasive Ventilation in Critically Ill Children: Secondary Analysis of the NIV Dex EN Study

Authors

• Charlene P. Pringle, Department of Pediatrics, Critical Care Medicine, University of Florida, USAFollow
• Peter Chang, Department of Pediatrics, Pediatric Research Hub, University of Florida, USA
• Joie Cavazos, Department of Pediatrics, Critical Care Medicine, University of Florida, USA
• Tristan Dorn, Department of Pediatrics, Critical Care Medicine, University of Florida, USA
• Christine Allen, University of Oklahoma, USA
• K. Leslie Avery, Department of Pediatrics, Critical Care Medicine, University of Florida, USA
• Torrey Baines, Department of Pediatrics, Critical Care Medicine, University of Florida, USA
• Samantha Gee, Nationwide Children’s Hospital and The Ohio State University Department of Pediatrics, Division of Critical Care, USA
• Nekaiya Jacobs, Advocate Children’s Hospital, Division of Pediatric Critical Care, Department of Pediatrics, USA
• Jodi J. Bloxham, Stead Family Children's Hospital, University of Iowa Health Care, Department of Pediatrics, Pediatric Intensive Care Unit, USA
• Elizabeth M. Brothers, Wolfson Children’s Hospital, Pediatric Intensive Care Unit, USA
• Elizabeth Elliott, Children's National Hospital, Division of Critical Care Medicine, USA
• Shannon Faulkinberry, Arnold Palmer Hospital, Division of Pediatric Critical Care, Pediatric Department, USA
• Emily F. Goldhar, Lefkovsky Pediatric Intensive Care Unit, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
• Stephanie C. Hsu, University of Texas Southwestern Medical Center, Children’s Health Medical Center Dallas, Division of Critical Care Medicine, USA
• K. Meghan Kendall, University of Nebraska/Children’s Hospital of Nebraska, USA
• Christine Koshel, Nemours Children's Hospital, Division of Critical Care, USA
• Ada T. Lin, Nationwide Children’s Hospital and The Ohio State University Department of Pediatrics, Division of Critical Care, USA
• Kristin K. Magner, Medical College of Wisconsin/Children’s Wisconsin, USA
• Krishna S. Siruguppa, Department of Pediatrics, University of California San Francisco Fresno Medical Education Program, USA
• Kitman Wai, Children's National Hospital, Division of Critical Care Medicine, USA
• Anna Wanzenberg, UCF College of Medicine, USA
• Ann-Marie Brown, Nell Hodgson Woodruff School of Nursing, Emory University; Children’s Healthcare of Atlanta; ECU Health, USA

Abstract

Introduction: Despite the widespread use of non-invasive ventilation (NIV) in pediatric intensive care units (PICUs), little has been published regarding enteral nutrition (EN) in this setting. This pre-planned secondary analysis of the Association of Enteral Nutrition and Dexmedetomidine Usage for Critically Ill Children Requiring Non-Invasive Ventilation study aimed to describe current feeding practices during NIV in a large sample, including differences in timing, energy and protein delivery across NIV modes and interfaces. Methods: Secondary analysis of a retrospective study of 1763 patients acutely supported with NIV over one year in fourteen PICUs in the United States. Results: 1065 subjects (60.4%) received EN, with younger children fed vs not fed (median [IQR] 12 months [4,72] vs 24 months [9,96], p<0.001). The overall median (IQR) of energy delivered as a percentage of the goal was 105% (79,121). The overall median (IQR) of the protein delivered was 79% (61,86) of the benchmark. Most were fed via gastric route [50% PO (including 5% breastfed), 20% NG and 16.5% GT] vs. 13.5% post-pyloric. Both NIV interface (p<0.001) and modality (p<0.001) were associated with timing of initiation of EN. NIV failure rate was higher in those not fed n=76 (10.8%) vs n=24(2.2%); p<0.0001. Conclusion: In this large sample exploring current practices of EN provided during NIV support in pediatric ICUs, the majority of children were fed. Documenting this prevalence highlights the need for development of feeding pathways or protocols for critically ill children acutely supported with NIV, as well as provides background for future research foci.

Recommended Citation

Pringle, Charlene P.; Chang, Peter; Cavazos, Joie; Dorn, Tristan; Allen, Christine; Avery, K. Leslie; Baines, Torrey; Gee, Samantha; Jacobs, Nekaiya; Bloxham, Jodi J.; Brothers, Elizabeth M.; Elliott, Elizabeth; Faulkinberry, Shannon; Goldhar, Emily F.; Hsu, Stephanie C.; Kendall, K. Meghan; Koshel, Christine; Lin, Ada T.; Magner, Kristin K.; Siruguppa, Krishna S.; Wai, Kitman; Wanzenberg, Anna; and Brown, Ann-Marie (2026) "Enteral Nutrition Practices during Non-invasive Ventilation in Critically Ill Children: Secondary Analysis of the NIV Dex EN Study," Journal of Pediatric Intensive Care: Vol. 15: Iss. 1, Article 9.
DOI: https://doi.org/10.53391/2146-4618.1082
Available at: https://jpic.researchcommons.org/journal/vol15/iss1/9