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theses

ETD doctoral

Purpose of the Project: The objective of this review was to evaluate the effect of post pyloric versus nasogastric feeding on microaspiration, aspiration pneumonia, and feeding intolerance events in critically ill children admitted to the pediatric intensive care unit (PICU).

The provision of optimal nutrition is a fundamental therapy in the management of critically ill children. Considerable variability of enteral feeding practices exists throughout PICUs worldwide which have resulted in inadequate nutrient delivery and malnutrition that is correlated to increased morbidity and mortality. The effect of the different enteral feeding routes on the rates of microaspiration, aspiration pneumonia, and feeding intolerance among critically ill children needs to be determined.

Methodology: Participants included children aged from one day of life to 18 years of age admitted to the PICU and requiring enteral tube feeding. Studies considered for review were both experimental and quasi-experimental designs including randomized controlled trials, non-randomized controlled trials, before and after studies, and interrupted time-series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case-control studies, and analytical cross-sectional studies were considered for inclusion. This review also considered descriptive observational study designs including case series, individual case reports, and descriptive cross-sectional studies for inclusion. Outcomes of interest were the effects of the route of enteral feeding on microaspiration, aspiration pneumonia, and feeding intolerance.

A three-step search strategy was used to search for published and unpublished studies in the English language. No search range (years) was set. Two independent reviewers assessed the studies for inclusion/exclusion criteria. The methodological quality of the potential studies for inclusion were assessed using the critical appraisal checklist for randomized controlled trials as recommended by the Joanna Briggs Institute (JBI). Data were extracted by two people independently and entered into the JBI extraction tool. Extracted data were pooled in a meta-analysis based on the random effects model.

Results: Three randomized controlled trials involving 146 participants were included in the review. Meta-analysis of the three trials demonstrated no effect of post pyloric feeding on microaspiration frequency when compared to nasogastric tube feeding (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.54-1.36; p=0.515, I2=57%); nor aspiration pneumonia (OR: 0.55, 95% CI: 0.11-2.84; p=0.478, I2=0%). Feeding intolerance was insufficiently defined in two studies therefore no pooling of data was able to be performed.

Implications for Practice: There is currently insufficient evidence to support or refute the use of post pyloric compared with nasogastric tube feedings in critically ill children. The available evidence indicates there are no significant differences for the outcomes measured. Although the results are based on single-center trials with small sample sizes, the meta-analyses revealed a strong homogeneity across the three studies. Further research should focus on describing the unique characteristics of post pyloric feeding practice standards

ETD_11312

DNP

Includes bibliographical references

doi:10.7282/t3-akvs-n931

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