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

TL;DR

This study finds that vasoactive drugs do not prevent early feeding in children on ECMO, but higher drug use is linked to lower energy intake.

Contribution

The study is the first to show that vasoactive drugs don't delay early enteral nutrition in pediatric ECMO patients, but higher drug scores correlate with inadequate energy intake.

Findings

Vasoactive-inotropic drug use does not prevent early enteral nutrition initiation in pediatric ECMO patients.

Higher vasoactive-inotropic scores in the first 48 hours are linked to lower energy intake.

Delayed enteral nutrition is associated with worse clinical outcomes and more frequent feeding interruptions.

Abstract

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.

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.

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).

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.

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