Clinical practice insight: vasoactive-inotropic drugs do not impede early enteral nutrition in pediatric ECMO support.

OBJECTIVE

To evaluate whether vasoactive-inotropic drug use impedes the early initiation of enteral nutrition (EN) and affects energy intake adequacy in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support.

METHODS

A prospective observational cohort study was conducted among pediatric ECMO patients between June 2018 and June 2024. Patients were categorized into early (≤ 48 h) and delayed (> 48 h) EN initiation groups, and into energy-deficient (< 30% of energy target) and non-deficient (≥ 30%) groups based on daily EN energy intake during the first five ECMO days. Vasoactive-Inotropic Score (VIS), PRISM III score, EN interruptions, and energy intake adequacy were analyzed. Spearman correlation and Cohen's d were used to explore associations between VIS and EN intake. A support vector machine (SVM) model was used to identify predictors of energy intake status.

RESULTS

A total of 64 patients were included, with 43 (67.2%) receiving EN within 48 h. VIS did not significantly differ between early and delayed EN groups. Delayed EN was associated with higher PRISM III scores (P = 0.037), lower EN energy intake (P < 0.001), and more frequent EN interruptions (P = 0.028). Among patients with EN intake <30% of the target, VIS was significantly higher (P < 0.05). VIS on days 1 and 2 were the top predictors in the SVM model (25.7% and 27.4%, respectively).

CONCLUSION

Vasoactive-inotropic drug use does not impede the early initiation of EN in pediatric ECMO patients. However, higher VIS in the initial 48 h is associated with suboptimal energy delivery. These findings suggest that while EN can be started early despite vasoactive support, closer monitoring of hemodynamic status is warranted to optimize nutritional adequacy.