Feeding during High-Flow Nasal Cannula for Bronchiolitis: Associations with Time to Discharge.

Autor: Shadman KA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Kelly MM; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Edmonson MB; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Sklansky DJ; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Nackers K; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Allen A; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Barreda CB; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Thurber AS; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Coller RJ; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Jazyk: angličtina
Zdroj: Journal of hospital medicine [J Hosp Med] 2019 Sep 18; Vol. 14, pp. E43-E48. Date of Electronic Publication: 2019 Sep 18.
DOI: 10.12788/jhm.3306
Abstrakt: Background: High-flow nasal cannula (HFNC) is increasingly used to treat children hospitalized with bronchiolitis; however, the best practices for feeding during HFNC and the impact of feeding on time to discharge and adverse events are unknown. The study objective was to assess whether feeding exposure during HFNC was associated with time to discharge or feeding-related adverse events.
Methods: This retrospective cohort study included inpatients aged 1-24 months receiving HFNC for bronchiolitis at an academic children's hospital from January 1, 2015 to March 1, 2017. Feeding exposures during HFNC were categorized as fed or not fed. Among fed children, we further evaluated mixed (oral and tube) or exclusive oral feeding. The primary outcome was time to discharge after HFNC cessation. Secondary outcomes were aspiration, intubation after HFNC, and seven-day readmission.
Results: Of 123 children treated with HFNC, 45 (37 %) were never fed. A total of 78 children (63%) were fed; 50 (41%) were exclusively orally fed and 28 (23 %) had mixed feeding. Median (interquartile range) time to discharge after HFNC was 29.5 hours (23.5-47.9) and 39.8 hours (26.4-61.5) hours in the fed and not fed groups, respectively. In adjusted models, time to discharge was shorter with any feeding (hazard ratio [HR] 2.17; 95% CI: 1.34-3.50) and with exclusive oral feeding (HR 2.13; 95% CI: 1.31-3.45) compared with no feeding. Time to discharge from HFNC initiation was shorter for exclusive oral feeding versus not feeding (propensity weighted HR 1.97 [95% CI: 1.13-3.43]). Adverse events (one intubation, one aspiration pneumonia, one readmission) occurred in both groups.
Limitations: Assessment of feeding exposure did not account for quantity and duration.
Discussion: Children fed while receiving HFNC for bronchiolitis may have shorter time to discharge than those not fed. Feeding-related adverse events were rare regardless of the feeding method. Controlled prospective studies addressing residual confounding are needed to justify a change in the current practice.
Databáze: MEDLINE
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