Safety and clinical efficacy of early enteral nutrition in children with extracorporeal membrane oxygenation: A retrospective cohort study.

BACKGROUND AND AIMS: The benefits of enteral nutrition (EN) in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) are increasingly recognized; however, data on the safety and clinical effectiveness of early EN initiation in this population remain limited. We aimed to assess whether early EN would increase the incidence of feeding intolerance and ECMO-related complications, and improve clinical outcomes in pediatric ECMO patients.

METHODS

We conducted a retrospective analysis of clinical data from 45 pediatric patients who underwent ECMO for more than 48 h between January 2018 and October 2024. Patients were divided into early EN (initiated within 48 h post-ECMO) and delayed EN (initiated after 48 h post-ECMO) groups. A multivariate Cox proportional hazards regression model was used to calculate the adjusted hazard ratio (HR) and 95 % confidence interval (95 % CI).

RESULTS

Forty-five patients were enrolled in the study, of whom 30 (66.7 %) received early EN. On ECMO days 2, 5, and 7, the median energy intake from EN in the early EN group was 233 kcal (Inter quartile range (IQR): 120, 421), 368 kcal (IQR: 165, 568), and 358 kcal (IQR: 135, 758), respectively, representing 41.0 %, 56.9 %, and 66.7 % of the prescribed energy target. By ECMO day 7, 15 patients (50 %) in the early EN group achieved the target energy intake, compared with 26.7 % in the delayed EN group (P = 0.135). No significant differences were observed in ECMO-related complications (60 % vs 66.7 %, P = 0.664) and feeding intolerance (63.3 % vs 66.7 %, P = 0.826) between the two groups. Bleeding at the cannulation site was the most frequent ECMO-related complication (35.6 %), while gastrointestinal bleeding (24.4 %) and constipation (17.8 %) were the primary reasons for feeding intolerance. Successful ECMO weaning was achieved in 33 patients (73.3 %), with a higher rate in the early EN group than in the delayed EN group (86.7 % vs 46.7 %, P = 0.012). The early EN group had a higher survival rate (76.7 %) compared with the delayed EN group (40 %, P = 0.015). Early EN was associated with a significant reduction in mortality, with an adjusted HR of 0.13 (95 % CI: 0.03, 0.55).

CONCLUSIONS

Early EN demonstrated a favorable safety profile and effectively managed the increased intestinal load in pediatric patients, with the potential to reduce in-hospital mortality among children receiving ECMO. For pediatric patients undergoing ECMO, initiating EN at a low volume or low rate within 48 h of ECMO initiation is recommended.