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Owens J, Qiu H, Knoblich C, Gerjevic L, Izard J, Xu L, Lee J, Kollala SS, Murry DJ, Riethoven JJ, Davidson JA, Singh AB, Ibrahimiye A, Ortmann L, Salomon JD. Feeding intolerance after pediatric cardiac surgery is associated with dysbiosis, barrier dysfunction, and reduced short-chain fatty acids. Am J Physiol Gastrointest Liver Physiol 2024; 327:G685-G696. [PMID: 39224072 DOI: 10.1152/ajpgi.00151.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/12/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Congenital heart disease (CHD) is the most common birth defect, occurring in roughly 40,000 U.S. births annually. Malnutrition and feeding intolerance (FI) in CHD range from 30% to 42% and are associated with longer hospitalization and increased mortality. Cardiopulmonary bypass (CPB) required for surgical repair of CHD induces a systemic inflammatory response worsening intestinal dysbiosis and leading to intestinal epithelial barrier dysfunction (EBD), possibly contributing to postoperative FI. The objective of this study was to determine the relationship of postoperative FI with intestinal microbiome, short-chain fatty acids (SCFAs), and EBD in pediatric CHD after cardiac surgery. This was a prospective study of patients aged 0-15 years undergoing cardiac surgery with CPB. Samples were collected preoperatively and postoperatively to evaluate the gut microbiome, plasma EBD markers, short-chain fatty acids (SCFAs), and plasma cytokines. Clinical data were collected to calculate a FI score and evaluate patient status postoperatively. We enrolled 26 CPB patients and identified FI (n = 13). Patients with FI had unique microbial shifts with the reduced SCFA-producing organisms Rothia, Clostridium innocuum, and Intestinimonas. Patients who developed FI had associated elevations in the plasma EBD markers claudin-2 (P < 0.05), claudin-3 (P < 0.01), and fatty acid binding protein (P < 0.01). Patients with FI had reduced plasma and stool SCFAs. Mediation analysis showed the microbiome functional shift was associated with reductions in stool butyric and propionic acid in patients with FI. In conclusion, we provide novel evidence that intestinal dysbiosis, markers of EBD, and SCFA depletion are associated with FI. These data will help identify mechanisms and therapeutics to improve clinical outcomes following pediatric cardiac surgery.NEW & NOTEWORTHY Feeding intolerance contributes to postoperative morbidity following pediatric cardiac surgery. The intestinal microbiome and milieu play a vital role in gut function. Short-chain fatty acids are gut and cardioprotective metabolites produced by commensal bacteria and help maintain appropriate barrier function. Depletion of these metabolites and barrier dysfunction contribute to postoperative feeding intolerance following cardiac surgery. Identifying mechanistic targets to improve the intestinal milieu with the goal of improved nutrition and clinical outcomes is critical.
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Affiliation(s)
- Jacob Owens
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Haowen Qiu
- Nebraska Center for Biotechnology, University of Nebraska Lincoln, Lincoln, Nebraska, United States
| | - Cole Knoblich
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Lisa Gerjevic
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Jacques Izard
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Frederick F. Paustian IBD Center, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Linda Xu
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Junghyae Lee
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Sai Sundeep Kollala
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Daryl J Murry
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Jean Jack Riethoven
- Nebraska Center for Biotechnology, University of Nebraska Lincoln, Lincoln, Nebraska, United States
| | - Jesse A Davidson
- Department of Pediatrics, University of Colorado, Aurora, Colorado, United States
| | - Amar B Singh
- Research Service, Nebraska-Western Iowa Health Care System, Omaha, Nebraska, United States
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Ali Ibrahimiye
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Laura Ortmann
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Jeffrey D Salomon
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, United States
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Alizadeh F, Gauvreau K, Barreto JA, Hall M, Bucholz E, Nathan M, Newburger JW, Vitali S, Thiagarajan RR, Chan T, Moynihan KM. Child Opportunity Index and Pediatric Extracorporeal Membrane Oxygenation Outcomes; the Role of Diagnostic Category. Crit Care Med 2024; 52:1587-1601. [PMID: 38920540 DOI: 10.1097/ccm.0000000000006358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVES To study the impact of social determinants of health (SDoH) on pediatric extracorporeal membrane oxygenation (ECMO) outcomes. DESIGN, SETTING, AND PATIENTS Retrospective study of children (< 18 yr) supported on ECMO (October 1, 2015 to March 1, 2021) using Pediatric Health Information System (44 U.S. children's hospitals). Patients were divided into five diagnostic categories: neonatal cardiac, pediatric cardiac, neonatal respiratory, pediatric respiratory, and sepsis. SDoH included the Child Opportunity Index (COI; higher indicates social advantage), race, ethnicity, payer, and U.S. region. Children without COI were excluded. Diagnostic category-specific clinical variables related to baseline health and illness severity were collected. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Children supported on ECMO experienced a 33% in-hospital mortality (2863/8710). Overall, children with lower COI, "other" race, Hispanic ethnicity, public insurance and from South or West regions had greater mortality. Associations between SDoH and ECMO outcomes differed between diagnostic cohorts. Bivariate analyses found that only pediatric cardiac patients had an association between COI or race and mortality. Multivariable logistic regression analyses examined relationships between SDoH, clinical variables and mortality within diagnostic categories. Pediatric cardiac patients had 5% increased odds of death (95% CI, 1.01-1.09) for every 10-point decrement in COI, while Hispanic ethnicity was associated with higher survival (adjusted odds ratio [aOR] 0.72 [0.57-0.89]). Children with heart disease from the highest COI quintile had less cardiac-surgical complexity and earlier cannulation. Independent associations with mortality were observed in sepsis for Black race (aOR 1.62 [1.06-2.47]) and other payer in pediatric respiratory patients (aOR 1.94 [1.23-3.06]). CONCLUSIONS SDoH are statistically associated with pediatric ECMO outcomes; however, associations differ between diagnostic categories. Influence of COI was observed only in cardiac patients while payer, race, and ethnicity results varied. Further research should investigate differences between diagnostic cohorts and age groups to understand drivers of inequitable outcomes.
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Affiliation(s)
- Faraz Alizadeh
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jessica A Barreto
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Emily Bucholz
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Sally Vitali
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Department of Anesthesia, Harvard Medical School, Boston, MA
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Titus Chan
- The Heart Center, Seattle Children's Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Luo C, Yin J, Sha Y, Gong W, Shen L. Trends and development in perioperative enteral nutrition: a systematic bibliometric analysis. Front Nutr 2024; 11:1406129. [PMID: 39346647 PMCID: PMC11427385 DOI: 10.3389/fnut.2024.1406129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 09/02/2024] [Indexed: 10/01/2024] Open
Abstract
Background This research aims to explore the intellectual landscape of studies in perioperative enteral nutrition (PEN) and identify trends and research frontiers in the field. Methods Scientometric research was conducted through the analysis of bibliographic records from the Web of Science Core Collection Database for the period 2014-2023. Analyses performed using CiteSpace software included cooperation network analysis, reference co-citation analysis, and keywords co-occurrence analysis. Results The analysis included 3,671 valid records in the final dataset. Findings indicate an upward trend in annual publications, with the United States leading in research output and Harvard University as the top publishing institution. The Journal of Parenteral and Enteral Nutrition was identified as the most productive journal. Notable research hotspots include enhanced recovery after surgery, early enteral nutrition, intestinal failure, short bowel syndrome, abdominal surgery. Evidence-based articles have emerged as the predominant literature type. Future research trends are anticipated to focus on gut microbiota and patients with congenital heart disease. Conclusion Our study provides a comprehensive analysis of the publication volume, contributions by country/region and institutions, journal outlets, and reference and keyword clusters in the field of PEN over the decade. The findings provide valuable insights for researchers, policymakers, and clinicians, helping them comprehend the research landscape, identify gaps, and shape future research directions in this field.
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Affiliation(s)
- Chen Luo
- Department of Nursing, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianing Yin
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yuejiao Sha
- Department of Pediatric Critical Care Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Gong
- Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Biliary Tract Disease Research, Research Institute of Biliary Tract Disease, Shanghai Research Center of Tract Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Shen
- Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kołodziej M, Skulimowska J. A Systematic Review of Clinical Practice Guidelines on the Management of Malnutrition in Children with Congenital Heart Disease. Nutrients 2024; 16:2778. [PMID: 39203914 PMCID: PMC11356818 DOI: 10.3390/nu16162778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 09/03/2024] Open
Abstract
Congenital heart disease (CHD) is one of the most common inborn disorders, with a prevalence of 0.8-1.2%. Affected children are often malnourished due to increased dietary requirements. This may lead to severe long-term complications. Several authoritative organizations have published guidelines addressing nutritional intervention in children with CHD. We aimed to systematically assess the consistency of recommendations, the methodological quality of these guidelines, and the quality of evidence supporting each recommendation. PubMed, Embase, the Cochrane Database, World Health Organization Global Index Medicus, and 16 scientific societies' websites were searched for the period until September 2023. The guideline quality was assessed using the AGREE II tool. After screening 765 records, only 2 guidelines published in 2013 and 2022 met our inclusion criteria. The main reason for exclusion was the absence of any system for rating the evidence. The main issues concerned the lack of implementation advice or tools and the lack of criteria to measure the application of guideline recommendations. The included guidelines were of good quality and within specific recommendations, both publications were largely in agreement, and the score for the overall assessment was high (83%). There is a pressing need for comprehensive, multi-threaded guidelines incorporating implementation strategies and methods for the performance assessment of children with malnutrition and CHD.
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Affiliation(s)
- Maciej Kołodziej
- Department of Pediatrics, The Medical University of Warsaw, 02-091 Warsaw, Poland;
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5
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Zhang C, Xu B, Zhu C, Pu K, Bian L. Risk factors of malnutrition in children with congenital heart disease: a meta-analysis. Front Pediatr 2024; 12:1258725. [PMID: 39135858 PMCID: PMC11317268 DOI: 10.3389/fped.2024.1258725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/08/2024] [Indexed: 08/15/2024] Open
Abstract
Background The associated factors of malnutrition in children with congenital heart disease (CHD) must be evaluated to provide evidence for the treatment and care of such children. Methods Two investigators searched the PubMed database until 25 June 2023 for literature about the associated factors of malnutrition in children with CHD. A meta-analysis of associated factors of malnutrition was performed by RevMan 5.3 software. Results Thirteen studies involving 8,031 children with CHD were included. Pulmonary hypertension (OR = 3.81, 95% CI: 2.46-4.12), low birth weight (OR = 2.69, 95% CI: 1.25-5.77) and parents' height (OR = 2.15, 95% CI: 1.89-2.92) were the associated factors of growth retardation (all P < 0.05). Pulmonary hypertension (OR = 3.77, 95% CI: 3.13-4.24), low birth weight (OR = 3.04, 95% CI: 2.61-4.18) and pneumonia (OR = 2.35, 95% CI: 2.08-2.83) were the associated factors of low body weight of children with CHD (all P < 0.05). Conclusions Medical staff should fully understand the risk factors, strengthen nutritional support and enhance nursing care for children with CHD to reduce malnutrition.
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Affiliation(s)
| | | | | | - Kai Pu
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Lanzheng Bian
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Martin N, Urbina T. Follow-up of a Term Infant with a Prenatal Diagnosis of Double-Outlet Right Ventricle. Neoreviews 2024; 25:e466-e473. [PMID: 38945967 DOI: 10.1542/neo.25-7-e466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Nicole Martin
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Theresa Urbina
- Department of Neonatology, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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Trisauvapak T, Bongkotwilawan N, Ekawaravong S. Challenges of managing anomalous mitral arcade with severe mitral regurgitation and hydrops fetalis in infants. BMJ Case Rep 2024; 17:e259272. [PMID: 38866580 PMCID: PMC11177271 DOI: 10.1136/bcr-2023-259272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
Anomalous mitral arcade (MA) is a rare congenital anomaly. We report a case of MA in a newborn who presented with hydrops fetalis due to severe mitral regurgitation. After birth, he developed severe respiratory failure, congestive heart failure and airway obstruction because an enlarged left atrium from severe mitral regurgitation compressed the distal left main bronchus. There is limited experience in surgical management of this condition in Thailand, and the patient's mitral valve was too small for replacement. Therefore, he was treated with medication to control heart failure and supported with positive pressure ventilation to promote growth. We have followed the patient until the current time of writing this report at the age of 2 years, and his outcome is favourable regarding heart failure symptoms, airway obstruction, growth and development. This case describes a challenging experience in the non-surgical management of MA with severe regurgitation, which presented at birth.
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Affiliation(s)
- Tienake Trisauvapak
- Pediatrics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Bang phli, Thailand
| | - Nitiroj Bongkotwilawan
- Pediatrics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Bang phli, Thailand
| | - Suparat Ekawaravong
- Pediatrics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Bang phli, Thailand
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8
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Miller AN, Curtiss J, Kielt MJ. Nutritional Needs of the Infant with Bronchopulmonary Dysplasia. Neoreviews 2024; 25:e12-e24. [PMID: 38161180 DOI: 10.1542/neo.25-1-e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Growth failure is a common problem in infants with established bronchopulmonary dysplasia (BPD). Suboptimal growth for infants with BPD is associated with unfavorable respiratory and neurodevelopmental outcomes; however, high-quality evidence to support best nutritional practices are limited for this vulnerable patient population. Consequently, there exists a wide variation in the provision of nutritional care and monitoring of growth for infants with BPD. Other neonatal populations at risk for growth failure, such as infants with congenital heart disease, have demonstrated improved growth outcomes with the creation and compliance of clinical protocols to guide nutritional management. Developing clinical protocols to guide nutritional management for infants with BPD may similarly improve long-term outcomes. Given the absence of high-quality trials to guide nutritional practice in infants with BPD, the best available evidence of systematic reviews and clinical recommendations can be applied to optimize growth and decrease variation in the care of these infants.
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Affiliation(s)
- Audrey N Miller
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Jennifer Curtiss
- Department of Clinical Nutrition and Lactation, Nationwide Children's Hospital, Columbus, OH
| | - Matthew J Kielt
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Kerstein JS, Klepper CM, Finnan EG, Mills KI. Nutrition for critically ill children with congenital heart disease. Nutr Clin Pract 2023; 38 Suppl 2:S158-S173. [PMID: 37721463 DOI: 10.1002/ncp.11046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/19/2023] Open
Abstract
Children with congenital heart disease often require admission to the cardiac intensive care unit at some point in their lives, either after elective surgical or catheter-based procedures or during times of acute critical illness. Meeting both the macronutrient and micronutrient needs of children in the cardiac intensive care unit requires complex decision-making when considering gastrointestinal perfusion, vasoactive support, and fluid balance goals. Although nutrition guidelines exist for critically ill children, these cannot always be extrapolated to children with congenital heart disease. Children with congenital heart disease may also suffer unique circumstances, such as chylothoraces, heart failure, and the need for mechanical circulatory support, which greatly impact nutrition delivery. Guidelines for neonates and children with heart disease continue to be developed. We provide a synthesized narrative review of current literature and considerations for nutrition evaluation and management of critically ill children with congenital heart disease.
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Affiliation(s)
- Jason S Kerstein
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusettes, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
| | - Corie M Klepper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusettes, USA
| | - Emily G Finnan
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusettes, USA
| | - Kimberly I Mills
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusettes, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
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Brackmann M, Lintvedt A, Kogelschatz B, Heinze E, Parker JL, Ferguson K, Rosner E, Boville B, Leimanis-Laurens ML. Daily Nutritional Intake of Pediatric Patients (N = 64) on Extracorporeal Membrane Oxygenation from 2018 to 2022: A Single-Center Report. Nutrients 2023; 15:3221. [PMID: 37513638 PMCID: PMC10383656 DOI: 10.3390/nu15143221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Nutrition in pediatric populations who require life-saving extracorporeal membrane oxygenation (ECMO) remains a debate. We sought to identify if nutritional needs were met in a patient cohort. A retrospective chart review of patients (N = 64) requiring ECMO at Helen DeVos Children's Hospital between 2018 and 2022 was evaluated for demographics, daily nutritional data, laboratory values, ECMO complications, and outcome data, with primary outcome measures of percent protein and percent caloric intake. Secondary outcome measures included the intensive care unit length of stay, time on ECMO, mortality, and day 1 severity of illness scores (Pediatric Logistic Organ Dysfunction). The timeline partially overlapped with the COVID-19 pandemic. Data were collected for 467 ECMO days with a median age of 2.6 months; 57.8% of patients were male and 65.6% were with one pre-existing comorbidity. Venoarterial (VA) ECMO was utilized in 84.4% of patients; the ECMO indication was cardiac in 53.1% of patients. The 28-day mortality was 43.8%. The proportion of days in which the caloric goal was met was 0%; the proportion of days in which protein goals were met was 33.3%. Non-cardiac ECMO patients had a greater number of days where caloric goals were met (p-value = 0.04). Mortality at 28 days was not statistically significant (p-value = 0.28) for calories or protein administered. The patient cohort struggled to meet calorie and protein goals while on ECMO.
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Affiliation(s)
- Megan Brackmann
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Annika Lintvedt
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Benjamin Kogelschatz
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
- Pediatric Critical Care Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI 49503, USA
| | | | | | - Karen Ferguson
- Pediatric Critical Care Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI 49503, USA
| | - Elizabeth Rosner
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
- Pediatric Critical Care Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI 49503, USA
| | - Brian Boville
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
- Pediatric Critical Care Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI 49503, USA
| | - Mara L Leimanis-Laurens
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
- Pediatric Critical Care Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI 49503, USA
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