Association between enteral feeding and gastrointestinal complications in children receiving extracorporeal life support: A retrospective cohort study.

BACKGROUND: Extracorporeal life support is an accepted treatment modality for children with severe cardiac and/or respiratory dysfunction. However, after a period of inadequate gut perfusion, clinicians are often reluctant to initiate enteral nutrition. METHODS: This was a retrospective cohort study in a single large pediatric intensive care unit in North West England over 5.5 years (2017-2022). RESULTS: One hundred fifty-six children, who had a median age of 2 months (IQR, 0.3-15) and a mean weight-for-age z score of -1.50 (SD, 1.7), were included. Indications for extracorporeal life support were respiratory failure (31%), cardiac arrest (28%), low cardiac output state (27%), and inability to separate from cardiopulmonary bypass (12%). Most (75%) children were fed during extracorporeal life support, with a median time to initiate feeding of 24 h (IQR, 12.2-42.7). More gastrointestinal complications were associated with being enterally fed (86% vs 14%; P < 0.001), but complications were predominantly feed intolerance (46%), which was associated with receiving formula feeds rather than maternal (breast) milk (P < 0.001). Overall, the proportion of children's median energy targets achieved by 72 h was 38% (IQR, 10.7%-76%), but this varied by support indication. CONCLUSIONS: Our findings suggest most children tolerated enteral feeding within 24 h after extracorporeal life support initiation, with only mild gastrointestinal complications.

Low bilirubin kernicterus with sepsis and hypoalbuminaemia.

A near-term female neonate with total serum bilirubin levels not exceeding the exchange transfusion level with hypoalbuminaemia developed abnormal movements while recovering from sepsis. Investigations showed an evidence of kernicterus on brain imaging and bilateral auditory neuropathic changes.