Fasting times in the Pediatric Intensive Care Unit.

Background

Adequate enteral nutrition is associated with improved outcomes in hospitalized children. Common interruptions to enteral nutrition include fasting status for planned procedures. We sought to describe current fasting duration for patients in the pediatric intensive care unit (PICU) undergoing planned anesthesia events.

Methods

We completed a retrospective cohort study of patients ≤21 years old in a PICU from January 2015 to December 2020 who underwent a procedure or imaging study and were tolerating enteral nutrition prior to the procedure.

Results

A total of 189 patients met inclusion criteria. Anesthesia events requiring NPO status included radiologic studies (32.8%), neurosurgery (19.6%) and general surgery (13.8%). The median duration of fasting status was 13.3 h (IQR 8.0-23.0), exceeding recommendations of 2-6 h at our institution. Thirty-five patients (18.5%) were intubated prior to NPO status. Forty-five (23.8%) of NPO orders were placed to start at midnight.

Conclusion

This study shows that fasting duration in children previously tolerating enteral nutrition in the PICU can exceed the recommended minimum duration in non-emergent cases requiring anesthesia. An opportunity exists to evaluate barriers and facilitators to enhance active decision making surrounding fasting status for hospitalized patients undergoing planned anesthesia events to maximize nutrition and minimize harm.

Impact

Adequate enteral nutrition is crucial to healing in hospitalized children, especially those who are critically ill in the PICU. Interruptions to enteral nutrition are common in hospitalized patients. In this study, we demonstrate that children in the PICU who were previously tolerating enteral nutrition and underwent a planned general anesthesia event were made nil per os (NPO) for a median time of over 13 h, which exceeds institutional and societal guidelines of 2-6 h. This study has identified opportunities to improve compliance with fasting guidelines for this population to reduce enteral nutrition interruptions for hospitalized patients in the PICU.

References:

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• Tume, L. N. et al. Nutritional support for children during critical Illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intens. Care Med. 46, 411–425 (2020).
• Nabialek, T. et al. Planned Peri-Extubation Fasting in Critically Ill Children: An International Survey of Practice. Front. Pediatr. 10, 905058 (2022).