• Vijay Srinivasan, Natalie R Hasbani, Nilesh M Mehta, Sharon Y Irving, Sarah B Kandil, H Christine Allen, Katri V Typpo, Natalie Z Cvijanovich, Faustino E Vincent S EVS Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT., David Wypij, Agus Michael S D MSD Division of Medical Critical Care, Boston Children's Hospital, Boston, MA., Vinay M Nadkarni, and Heart and Lung Failure-Pediatric Insulin Titration (HALF-PINT) Study Investigators.
• Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
• Pediatr Crit Care Me. 2020 Mar 1; 21 (3): 213-221.

ObjectivesThe impact of early enteral nutrition on clinical outcomes in critically ill children has not been adequately described. We hypothesized that early enteral nutrition is associated with improved clinical outcomes in critically ill children.DesignSecondary analysis of the Heart and Lung Failure-Pediatric Insulin Titration randomized controlled trial.SettingThirty-five PICUs.PatientsCritically ill children with hyperglycemia requiring inotropic support and/or invasive mechanical ventilation who were enrolled for at least 48 hours with complete nutrition data.InterventionsSubjects received nutrition via guidelines that emphasized enteral nutrition and were classified into early enteral nutrition (enteral nutrition within 48 hr of study randomization) and no early enteral nutrition (enteral nutrition after 48 hr of study randomization, or no enteral nutrition at any time).Measurements And Main ResultsOf 608 eligible subjects, 331 (54%) received early enteral nutrition. Both early enteral nutrition and no early enteral nutrition groups had similar daily caloric intake over the first 8 study days (median, 36 vs 36 kcal/kg/d; p = 0.93). After controlling for age, body mass index z scores, primary reason for ICU admission, severity of illness, and mean Vasopressor-Inotrope Score at the time of randomization, and adjusting for site, early enteral nutrition was associated with lower 90-day hospital mortality (8% vs 17%; p = 0.007), more ICU-free days (median, 20 vs 17 d; p = 0.02), more hospital-free days (median, 8 vs 0 d; p = 0.003), more ventilator-free days (median, 21 vs 19 d; p = 0.003), and less organ dysfunction (median maximum Pediatric Logistic Organ Dysfunction, 11 vs 12; p < 0.001).ConclusionsIn critically ill children with hyperglycemia requiring inotropic support and/or mechanical ventilation, early enteral nutrition was independently associated with better clinical outcomes.

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