Impact of enteral nutrition initiated within 24 h of ECMO on nutritional status and inflammatory response in children.

Summary

In a prospective cohort of 47 pediatric ECMO patients, initiating enteral nutrition within 24 hours was associated with improved nutritional status, enhanced hepatic anabolic metabolism, and reduced inflammatory markers compared with later initiation. These findings support early enteral feeding as a feasible, beneficial strategy during ECMO.

Key Findings

• Among 47 children on ECMO, 51.1% achieved early enteral nutrition within 24 hours.
• Early enteral nutrition was associated with improved nutritional status and hepatic anabolic metabolism.
• Inflammatory responses were reduced with early feeding compared with later initiation.

Clinical Implications

When clinically feasible, initiate enteral nutrition within 24 hours of ECMO start to improve nutritional adequacy and attenuate inflammation; protocols should address hemodynamic stability and feeding tolerance.

Limitations

• Single-center study with small sample size (n=47).
• Nonrandomized design with potential confounding by illness severity (e.g., PRISM3 differences).

Future Directions

Randomized trials to test early vs delayed enteral feeding during ECMO; standardized feeding protocols with hemodynamic criteria; evaluation of clinical outcomes (ventilator days, infections, mortality).