Late Nutrition and Negative Outcomes in a Brazilian Paediatric Intensive Care Unit: A Retrospective Cohort

Abstract

Aim: To analyse the association between late initiation of enteral nutrition and negative outcomes in the Paediatric Intensive Care Unit (PICU) in Brazil. Method: This was a retrospective cohort study with data from the medical records of children hospitalised between 2012 and 2017. The independent variable was late initiation of enteral nutrition (> 24 h after admission). The outcomes analysed included longer length of stay in the PICU and hospital, incidence of healthcare-related infections (HAIs), and death. Poisson regression models with robust variance were adjusted for potentially confounding variables by presenting relative risks (RR) and 95% confidence intervals (95% CI). Results: We analysed 840 hospitalizations: 311 (37.0%) with delayed initiation of nutrition, 252 (30.0%) with a diagnosis of HAIs, and 93 deaths (11.1%). After all adjustments, late initiation of enteral nutrition was associated with longer lengths of stay in the PICU (RR: 1.41; 95% CI: 1.01–1.30), hospital stay (RR: 1.22; 95% CI: 1.06–1.41), and higher HAI incidence (RR: 1.40; 95% CI: 1.14–1.73). The association with mortality was no longer significant after adjusting for the admission severity indicators. Conclusion: The results indicate that late initiation of nutrition can lead to longer PICU and hospital stays and a higher incidence of HAIs.