# 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.

## Key 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.