title: Early enteral nutrition is associated with lower mortality in critically ill children.
abstract: BACKGROUND
  The purpose of this study was to examine the association of early enteral nutrition (EEN), defined as the provision of 25% of goal calories enterally over the first 48 hours of admission, with mortality and morbidity in critically ill children.
  
  
  METHODS
  We conducted a multicenter retrospective study of patients in 12 pediatric intensive care units (PICUs). We included patients aged 1 month to 18 years who had a PICU length of stay (LOS) of ≥96 hours for the years 2007-2008. We obtained patients' demographics, weight, Pediatric Index of Mortality-2 (PIM2) score, LOS, duration of mechanical ventilation (MV), mortality data, and nutrition intake data in the first 4 days after admission.
  
  
  RESULTS
  We identified 5105 patients (53.8% male; median age, 2.4 years). Mortality was 5.3%. EEN was achieved by 27.1% of patients. Children receiving EEN were less likely to die than those who did not (odds ratio, 0.51; 95% confidence interval, 0.34-0.76; P = .001 [adjusted for propensity score, PIM2 score, age, and center]). Comparing those who received EEN to those who did not, adjusted for PIM2 score, age, and center, LOS did not differ (P = .59), and the duration of MV for those receiving EEN tended to be longer than for those who did not, but the difference was not significant (P = .058).
  
  
  CONCLUSIONS
  EEN is strongly associated with lower mortality in patients with PICU LOS of ≥96 hours. LOS and duration of MV are slightly longer in patients receiving EEN, but the differences are not statistically significant.
authors.affiliation: Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Mikhailov
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Kuhn
authors.forename: Jennifer
authors.initials: J
authors.lastname: Manzi
authors.forename: Melissa
authors.initials: M
authors.lastname: Christensen
authors.forename: Maureen
authors.initials: M
authors.lastname: Collins
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Brown
authors.forename: Ronald
authors.initials: R
authors.lastname: Dechert
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Scanlon
authors.forename: Martin K
authors.initials: MK
authors.lastname: Wakeham
authors.forename: Praveen S
authors.initials: PS
authors.lastname: Goday
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D012121:Respiration, Artificial; D012189:Retrospective Studies
keywords: critically ill children; early enteral nutrition; mortality; outcomes; pediatrics