Background

Pediatric acute respiratory distress syndrome (PARDS) remains a significant cause of morbidity and mortality. Evidence suggests enteral nutrition (EN) may be protective in critically ill children. This study was designed to determine if an association exists between early enteral nutrition (EEN) and PARDS outcomes.

Methods

Retrospective cohort study comparing intubated patients with PARDS who received EEN and those who did not. We included intubated patients with PARDS aged 2 weeks to 18 years who could receive full nutrition enterally prior to their disease and excluded patients with cyanotic heart disease. Disease severity captured with oxygenation index (OI), oxygen saturation index (OSI), and pediatric logistic organ dysfunction (PELOD-2) scores. EEN defined as having received at least 25% of calculated caloric goal enterally within the first 48 hours of PARDS diagnosis. We compared PICU mortality, PICU length of stay (LOS), and 28-day ventilator-free days between EEN and non-EEN groups.

Results

We included 151 patients. Adjusted for age, OI, and OSI, the EEN group had a lower PICU mortality rate (aOR=0.071, 95% CI 0.009-0.542, p=0.011), higher likelihood of PICU discharge (aRR=1.79, 95% CI 1.25-2.55, p=0.001) and was more likely to have at least one ventilator-free day (aOR=3.96, 95% CI 1.28-12.22, p=0.017). Adjusted for age and PELOD-2, a statistically significant association between the EEN group and lower PICU mortality (p=0.033), shorter PICU LOS (p<0.001), and more ventilator-free days (p=0.037) persisted.

Conclusions

Our study found EEN was associated with superior mortality rates, PICU LOS, and ventilator-free days in patients with PARDS.

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