Child feeding in intensive care ‘not based on evidence’ – new study

Routinely assessing stomach volume in critically-ill children is unhelpful and reduces the patient’s nutritional intake, according to new research.

The practice, performed across UK paediatric intensive care units (PICUs) as frequently as 2-4 hourly, and commonly worldwide, is done to guide tube feeding – known as enteral nutrition – for very sick children who cannot chew or and swallow food normally.

Carried out by a team of researchers from Edge Hill University, the UK Paediatric Critical Care Society Study Group and the Intensive Care National Audit and Research Centre, led by Professor Tume who is now at Liverpool John Moores University (LJMU), the new study finds child feeding is impaired by the practice, and says stopping the assessments can save nursing time, cut healthcare costs, reduce the environmental impact and, most importantly, benefit critically ill children.

'Change needed'

Lyvonne Tume, Professor of Critical Care Nursing at LJMU and chief investigator, said: “The practice of assessing the stomach contents frequently is routinely done but has little or no evidence to support it.

“The results of our trial will change practice in children’s intensive care units across the UK and internationally.”

The researchers enrolled 4,700 children from 23 intensive care units across the UK and one in Switzerland to a trial where they did not have their stomach contents assessed.

The children suffered no adverse effects and, in fact, received significantly more calories in the first three days.

“Nutrition is important in children, more so than in adults, but we know that children receive only around half of the calories they are predicted to need whilst in intensive care, and poor nutrition is associated with worse outcomes,” said Professor Tume.

Need for nutrients

Keeley Hughes, mother of Caleb who was the first child enrolled on this trial said “Critically ill children need all the nutrients they can get and its clear the stomach content checks are unnecessary.”

Professor Tume added: “We are recommending that this routine practice be stopped and that UK PICUs should revise their clinical guidelines accordingly.”

She said the research team would work with the Paediatric Critical Care Society and the nurse educators’ group to amend the national PICU nurse competencies.  

The first presentation of the results will be at the Critical Care Reviews meeting in Belfast on the 12 June and will be published the same day in the Journal of the American Medical Association.

The study called GASTRIC-PICU was funded by the National Institute for Health and Care Research, Health Technology Assessment Stream.

Ends

Main contact:

Lyvonne Tume, Professor of Critical Care Nursing

Faculty of Health, Innovation and Technology

Liverpool John Moores University

Email: l.n.tume@ljmu.ac.uk 

Ph (direct) 0151 231 3465

Alder Hey Children's NHS FT

Email: Lyvonne.tume@alderhey.nhs.uk