Written by Kimiko Dunbar
Spoon Feed
Enteral feeding in patients with bronchiolitis requiring nasal non-invasive support (HFNC, CPAP, BiPAP) did not increase adverse events. In this limited study, feeding by mouth rather than NGT led to decreased risk of pneumonia and shortened length of stay.
Is PO feeding actually safer?
Enteral feeding in critically ill children, especially those with bronchiolitis, has been shown to be of benefit, but many clinicians are concerned about enteral feeds in patients requiring non-invasive support, given increased risk of aspiration. Data are lacking on the safety of enteral feeds in those receiving non-invasive support and the ideal route.
This retrospective single-center cohort study evaluated whether enteral feeding methods impact safety in infants with bronchiolitis on non-invasive nasal respiratory support (defined as HFNC, CPAP or BiPAP delivered via a nasal interface, i.e. cannula; nasal masks were excluded). Among 407 patients ≤24 months, nasogastric feeding compared to oral feeding was associated with a 4.65-fold increased odds of pneumonia (CI 1.16–18.6), though no differences were found in escalation of respiratory support. Oral feeding was linked to shorter PICU and hospital stays. This study has several limitations, including retrospective design and lack of data on the caloric intake of PO/NGT feeds. Further, feeding and respiratory support in patients with bronchiolitis is dynamic. Many patients in this study likely received numerous types of respiratory support, and those who were receiving NGT feeds likely PO fed at some point during their hospitalization as well.
How does this change my practice?
Like any good pediatrician, I want to feed the patient! Especially those with bronchiolitis who are young and generally have less caloric reserve. It’s surprising to me that NGT feeds actually increased risk of pneumonia. I wonder if those receiving PO feeds are just pacing themselves and moderating their intake. Overall, there are too many important limitations for me to make a practice change just yet – we’re not comparing apples to apples. Additionally, the authors don’t differentiate between superimposed and aspiration pneumonia. Are NGT feeds causing pneumonia, or are those getting NGT feeds inherently sicker, with a superimposed pneumonia?
Source
Enteral feeding in pediatric patients with bronchiolitis requiring non-invasive support via nasal interface. Pediatr Res. 2025 Mar 27. doi: 10.1038/s41390-025-04022-z. Epub ahead of print. PMID: 40148473
Agree/less invasive