Association between goal nutrition and intubation in patients with bronchiolitis on non-invasive ventilation: A retrospective cohort study.

Acute bronchiolitis causes many hospitalizations in children under 2 years old. Early enteral nutrition is associated with improved outcomes in these patients. However, often nutrition is withheld when patients require non-invasive respiratory support, due to risk of aspiration worsening respiratory failure, possibly requiring intubation. We hypothesize that achieving goal calories is associated with lower intubation rate in hospitalized children with bronchiolitis who require non-invasive ventilation.This retrospective cohort study examined the association between goal enteral nutrition (60% of dietary reference caloric intake) and intubation rates. We grouped patients by severity of illness and compared intubation rates in those who met goal calories to those who did not. We use stratified analysis methods (for both level of respiratory support and feeding route) to evaluate progression to intubation.Of the 272 patients, 215 met goal feeds. These groups had similar demographics, but the goal feeds group started on higher respiratory support in the PICU. We found that 4.65% of the patients who met goal feeds required intubation compared to 24.6% of patients who did not meet goal feeds (p<0.0001), even after controlling for respiratory status at admission and time of feed initiation and feeding route.We observed when adjusting for severity, feeding route, and respiratory support, achieving goal calories remained associated with a lower rate of intubation, without higher rates of aspiration. Confounding factors include practice variation and difference in severity of illness that objective scoring may have missed. This article is protected by copyright. All rights reserved.