Association between enteral feeding guideline implementation and early enteral nutrition in children with critical bronchiolitis: An uncontrolled before‐after study

Background Malnutrition is a common problem in the pediatric intensive care unit (PICU). Enteral nutrition is often withheld in patients with respiratory failure because of risk of aspiration and potential need for intubation, as seen in patients with critical bronchiolitis managed on noninvasive ventilation. Studies show that enteral nutrition guidelines improve feeding tolerance, reduce complications, and decrease time to optimal nutrition. Before June 2019, our PICU had no enteral feeding guidelines, leading to inconsistency with starting feedings and reaching goal nutrition. Our objective was to determine if there was an association between implementing an enteral feeding guideline and the percentage of patients with critical bronchiolitis on noninvasive ventilation who receive early enteral nutrition. Methods A single‐center retrospective study at a tertiary PICU provided the dataset for this study. We included patients with critical bronchiolitis aged ≤24 months, admitted to the PICU from November 2017 to March 2020, and managed on noninvasive ventilation. Our feeding guideline was implemented in June 2019. Our primary outcome was early enteral nutrition defined as achieving >25% of dietary reference intake by 48 h of PICU admission. Our secondary outcome was goal feeds defined as >60% of dietary reference intake during admission. We used chi‐square analysis to analyze these data. Our institution's registered dietitians use dietary reference intake to calculate goal feeds. Results With initiation of the enteral feeding guideline, the percentage of patients who met early enteral nutrition increased from 53% to 76% ( P < 0.001), and those who reached goal feeds increased from 75% to 84% ( P = 0.057). Conclusion This study demonstrates that following implementation of the enteral feeding guideline, a greater proportion of patients with critical bronchiolitis on noninvasive ventilation started feeds earlier and achieved goal enteral nutrition during admission.