Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition.
OBJECTIVE
To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children.


METHODS
A prospective, observational study.


METHODS
Pediatric intensive care unit.


METHODS
Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN).


METHODS
Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications.


RESULTS
Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 microg/kg/min and hypophosphatemia.


CONCLUSIONS
The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.
López-Herce
J
J
Pediatric Intensive Care Unit, Preventive and Quality Control Service (DV), Gregorio Marañón General University Hospital, Madrid, Spain. pielvi@ya.com
Santiago
M J
MJ
Sánchez
C
C
Mencía
S
S
Carrillo
A
A
Vigil
D
D
D058186:Acute Kidney Injury / Q000150:complications; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007008:Hypokalemia / Q000150:complications; D017674:Hypophosphatemia / Q000150:complications; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D011708:Pylorus; D012307:Risk Factors; D012769:Shock / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome