Nutrition and High-Flow Nasal Cannula Respiratory Support in Children With Bronchiolitis

OBJECTIVES: No guidelines are available regarding initiation of enteral nutrition in children with bronchiolitis on high-flow nasal cannula (HFNC) support. We hypothesized that the incidence of feeding-related adverse events (AEs) would not be associated with HFNC support. METHODS: This retrospective study included children ≤24 months old with bronchiolitis receiving HFNC in a PICU from September 2013 through April 2014. Data included demographics, respiratory support during feeding, and feeding-related AEs. Feeding-related AEs were extracted from nursing documentation and defined as respiratory distress or emesis. Feed route and maximum HFNC delivery were recorded in 8-hour shifts (6 am–2 pm, 2 pm–10 pm, and 10 pm–6 am). RESULTS: 70 children were included, with a median age of 5 (interquartile range [IQR] 2–10) months. HFNC delivery at feed initiation varied widely, and AEs related to feeding occurred rarely. Children were fed in 501 of 794 (63%) of nursing shifts, with AEs documented in only 29 of 501 (5.8%) of those shifts. The incidence of AEs at varying levels of respiratory support did not differ (P = .092). Children in the “early feeding” (fed within first 2 shifts) group (n = 22) had a shorter PICU length of stay (2.2 days [IQR 1.4–3.9] vs 3.2 [IQR 2.5–5.3], P = .006) and shorter duration of HFNC use (26.0 hours [IQR 15.8–57.0] vs 53.5 [IQR 37.0–84.8], P = .002), compared with children in the “late feeding” group (n = 48). CONCLUSIONS: In this small, single-institution patient cohort, feeding-related AEs were rare and not related to the delivered level of respiratory support.