Safety and Tolerance of Intraoperative Enteral Nutrition Support in Pediatric Burn Patients.

BACKGROUND Multiple surgical procedures required by patients with extensive thermal injuries impedes delivery of adequate nutrition support, leading to caloric deficits, weight loss, delayed wound healing, and increased length of stay. The standard practice at our institution for >20 years has been to continuously infuse postpyloric enteral nutrition (EN) during surgery. The purpose of this review was to examine the safety and efficacy of intraoperative EN support. METHODS A retrospective chart review of pediatric patients with burn injuries >30% total body surface area provided a 20-year (1995-2014) safety assessment associated with intraoperative feeding along with an evaluation of gastrointestinal tolerance and efficacy. Continuous variables were summarized by mean and SD, whereas categorical variables were summarized by counts and percentages. RESULTS The 20-year review confirmed the safety of intraoperative feeding, as the assessment of 434 patients revealed no incidence of aspiration. Patients were successfully fed during an average of 8.4 ± 6.5 surgical procedures and received EN support for a mean of 49.9 ± 31.7 days. Uninterrupted nutrition delivery was well tolerated with minimal gastrointestinal intolerance. Patients achieved an average nitrogen balance of 3.1 ± 2.8 and 70% maintained ±10% of their body weight at time of discharge. CONCLUSION EN has been safely provided with marginal intolerance during surgical procedures over the past 20 years. Continuous nutrition support with negligible interruption is integral to meet nutrient needs for wound healing, preservation of weight and nutrition parameters, and optimize length of stay in pediatric patients with extensive thermal injuries.

• Publication year

  2019

• Venue

  Nutrition in clinical practice

• Publication date

  2019-10-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1002/ncp.10399PMID 31448446
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Safety and efficacy of intraoperative gastric feeding during burn surgery.

  2019cited by this paper
• How long are burn patients really NPO in the perioperative period and can we effectively correct the caloric deficit using an enteral feeding "Catch-up" protocol?

  2018cited by this paper
• Safety and efficacy of uninterrupted perioperative enteral feeding in pediatric burn patients.

  2017cited by this paper
• Intraoperative Feeding Improves Calorie and Protein Delivery in Acute Burn Patients

  2017cited by this paper
• Epidemiology of pediatric burns and future prevention strategies—a study of 475 patients from a high-volume burn center in North India

  2017cited by this paper
• Improving Nutritional Support of Burn Service Patients by Increasing the Number of Days When 100% of Prescribed Formula Is Given

  2017cited by this paper
• Nutrition and metabolism in burn patients

  2017cited by this paper
• Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice

  2015cited by this paper
• Enteral Nutrition: What the Dietitian Prescribes Is Not What The Burn Patient Gets!

  2015cited by this paper
• International observational study of nutritional support in mechanically ventilated patients following burn injury.

  2015cited by this paper
• Nutrition and Anabolic Pharmacotherapies in the Care of Burn Patients.

  2014cited by this paper
• A pilot review of gradual versus goal re-initiation of enteral nutrition after burn surgery in the hemodynamically stable patient.

  2014cited by this paper
• Severity of illness influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness.

  2012cited by this paper
• Relationship between feeding tube site and respiratory outcomes.

  2011cited by this paper
• Enhancing Patient Safety: The Effect of Process Improvement on Bedside Fluoroscopy Time Related to Nasoduodenal Feeding Tube Placement in Pediatric Burn Patients

  2009cited by this paper
• The impact of admission diagnosis on gastric emptying in critically ill patients

  2007cited by this paper
• The effectiveness of caloric value of enteral nutrition in patients with major burns.

  2006cited by this paper
• Nutrition support strategies for severely burned patients.

  2005cited by this paper
• Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours.

  2003cited by this paper
• Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn.

  2003cited by this paper
• North American Summit on Aspiration in the Critically Ill Patient: consensus statement.

  2002cited by this paper
• Risk factors for aspiration.

  2002cited by this paper
• The 2002 Clinical Research Award. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns.

  2002cited by this paper
• Reversal of catabolism by beta-blockade after severe burns.

  2001cited by this paper
• Persistence of muscle catabolism after severe burn.

  2000cited by this paper
• Energy deficits associated with nasogastric feeding in patients with burns.

  2000cited by this paper
• Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting.

  1999cited by this paper
• The metabolic basis of the increase of the increase in energy expenditure in severely burned patients.

  1999cited by this paper
• The Metabolic Basis of the Increase in Energy Expenditure in Severely Burned Patients

  1999cited by this paper
• ANTICATABOLIC AND ANABOLIC STRATEGIES IN CRITICAL ILLNESS: A REVIEW OF CURRENT TREATMENT MODALITIES

  1998cited by this paper
• Enteral feeding during operative procedures in thermal injuries.

  1994cited by this paper
• Jonathan E. Rhoads Lecture. Body composition research: implications for the practice of clinical nutrition.

  1992cited by this paper
• Continuous enteral feeding and short fasting periods enhance perioperative nutrition in patients with burns.

  1992cited by this paper
• Risk of pulmonary aspiration among patients receiving enteral nutrition support.

  1992cited by this paper
• Nutritional immunomodulation in burn patients

  1990cited by this paper
• Effects of beta-blockade on energy metabolism following burns.

  1990cited by this paper
• Differential effects of three enteral dietary regimens on selected outcome variables in burn patients.

  1990cited by this paper
• Diarrhea in tube-fed burn patients: incidence, etiology, nutritional impact, and prevention.

  1988cited by this paper
• Weight Loss with Physiologic Impairment: A Basic Indicator of Surgical Risk

  1988cited by this paper
• The effect of route of nutrient administration on the nutritional state, catabolic hormone secretion, and gut mucosal integrity after burn injury.

  1987cited by this paper
• Aspiration pneumonia in patients fed through nasoenteral tubes.

  1986cited by this paper
• Mechanism of Prevention of Postburn Hypermetabolism and Catabolism by Early Enteral Feeding

  1984cited by this paper
• The moulded silicone shoe in the prevention of contractures involving the burn-injured foot

  1974cited by this paper
• Catecholamines: Znediator of the Hypermetabolic Response to Thermal Injury

  1974cited by this paper

• Improving retention of pediatric feeding tubes with a nasal bridle: a randomized controlled trial

  2025cites this paper
• Metabolic and Hormonal Changes in Pediatric Burn Patients: Mechanisms, Evidence, and Care Strategies

  2025cites this paper
• Pediatric Feeding Tubes: What the Staff Nurse Should Know

  2024cites this paper
• Update in Pediatric Burn Care

  2023cites this paper
• Safety and benefits of intraoperative enteral nutrition in critically ill pediatric burn patients: A systematic review and pooled analysis.

  2022cites this paper
• Burns in Children

  2020cites this paper
• The Pediatric Burn: Current Trends and Future Directions.

  2020cites this paper
• Pediatric burn resuscitation, management, and recovery for the pediatric anesthesiologist.

  2020cites this paper
• Evaluating the safety and efficacy of intraoperative enteral nutrition in critically ill burn patients: a systematic review and meta-analysis.

  2020cites this paper