310 - Daily Nutritional Intake of Pediatric Patients (N=64) on ECMO: Are we over or under feeding?

Poster Number: 310
Publication Number: 310.205

Megan Brackmann, Michigan State University College of Human Medicine, Grand Rapids, MI, United States; Annika Lintvedt, Michigan State University College of Human Medicine, Grand Rapids, MI, United States; Mara Leimanis-Laurens, Helen DeVos Children’s Hospital, Pediatric Intensive Care Unit; Assistant Professor, Dept. of Pediatrics and Human Development College of Human Medicine, Michigan State University, Grand Rapids, MI, United States; Karen B. Ferguson, Helen DeVos Children's Hospital, Grand Rapids, MI, United States; Jessica Parker, Helen DeVos Children's Hospital, Grand Rapids, MI, United States; Cherith A. Lane, Helen DeVos Children's Hospital, Hudsonville, MI, United States; Elizabeth A. Rosner, Spectrum Health, Grand Rapids, MI, United States; Brian M. Boville, Helen DeVos Children's Hospital, Grand Rapids, MI, United States; Benjamin Kogelschatz, MD, University of Utah, Salt Lake City, UT, United States; Erika Heinze, Helen DeVos Children's Hospital, Kentwood, MI, United States

Background:  


The NIH strategic plan for 2020-2030 outlines initiatives which highlight the importance of advancing nutrition research to improve clinical outcomes. Nutrition in the pediatric population who require life-saving extracorporeal membrane oxygenation (ECMO) regarding the route, timing, and content of feeds remains a debate.


Objective: We sought to identify whether nutritional needs were adequately met in a patient cohort (daily caloric and protein goals). The secondary objective was to quantify the timing and content of feeds related to several outcomes (mortality, intensive care unit (ICU) length of stay, time on ECMO).

Design/Methods: A retrospective chart review was performed involving a consecutive series of patients who required ECMO at Helen DeVos Children’s Hospital between 2018-2022, a high-volume urban quaternary care center (IRB#:  2020-505). Demographics, daily nutritional data and laboratory values, ECMO complications, and outcome data were collected. Quality control was performed on the manually entered data (the inter-rater reliability was 95%). The primary outcome measures were % protein and % caloric intake; adequate intake was defined as exceeding 90% of their prescribed goal. Secondary outcome measures included ICU length of stay, time on ECMO, mortality, and secondary organ dysfunction (as determined by Pediatric Logistic Organ Dysfunction (PELOD)), with an additional investigation for any differences pre- and during the Covid-19 pandemic.

Results: Nutrition data was collected over 467 total days on ECMO for 19 neonatal and 45 pediatric patients with a median age of 2.6 months. The cohort was 57.8% male with 65.6% of patients having at least one pre-existing comorbidity. Venoarterial (VA) ECMO was utilized in 83.9% of patients; 16.1% of patients required venovenous (VV) ECMO. ECMO indication was cardiac in 53.1% of patients. The 28-day mortality of the patient cohort was 43.8% (28 patients). The proportion of days the calorie goal was met was 0%; days the protein goal was met was 33.3%.  Non-cardiac ECMO patients had a greater number of days where their caloric goals were met (p-value=0.04).  Mortality at 28-days was not statistically significant (p-value=0.24) for total calories or protein administered in our single-center investigation.

Conclusion(s): The patient cohort struggled to meet calorie and protein goals while on ECMO suggesting the current feeding algorithms are not attainable for this population. Determining the appropriate nutrition goals while on ECMO and its relationship to outcomes will help clinicians personalize nutrition plans for these critically ill patients.