Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review

Brown, Ann-Marie; Madsen, Erik C.; Leonard, Charlene P.; Leslie, Sharon L.; Allen, Christine; Srinivasan, Vijay; Irving, Sharon Y.

doi:10.4037/ajcc2020850

Article navigation

Pediatric Critical Care| January 01 2020

Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review

Ann-Marie Brown, PhD, CPNP-AC/PC, CCRN;

Ann-Marie Brown, PhD, CPNP-AC/PC, CCRN

Ann-Marie Brown is an assistant clinical professor at Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a nurse practitioner in pediatric intensive care at Akron Children’s Hospital, Akron, Ohio. Erik C. Madsen is an assistant professor of pediatrics at Saint Louis University and a pediatric intensivist at Cardinal Glennon Children’s Hospital, St Louis, Missouri. Charlene P Leonard is a nurse practitioner in pediatric critical care medicine, University of Florida and UFHealth Shands Children’s Hospital, Gainesville, Florida. Sharon L. Leslie is a nursing informationist at Woodruff Health Sciences Center Library, Emory University. Christine Allen is associate professor of pediatrics at the Children’s Hospital of Oklahoma/University of Oklahoma, Oklahoma City, Oklahoma. Vijay Srinivasan is an assistant professor of anesthesiology, critical care, and pediatrics at Perelman School of Medicine at the University of Pennsylvania and a pediatric intensivist in the Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Sharon Y. Irving is an assistant professor of pediatric nursing at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, and a nurse practitioner in pediatric intensive and progressive care at Children’s Hospital of Philadelphia.

Corresponding author: Ann-Marie Brown, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322 (email: ann-marie.brown@emory.edu).

Search for other works by this author on:

This Site

PubMed

Google Scholar

Erik C. Madsen, MD, PhD;

Erik C. Madsen, MD, PhD

Ann-Marie Brown is an assistant clinical professor at Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a nurse practitioner in pediatric intensive care at Akron Children’s Hospital, Akron, Ohio. Erik C. Madsen is an assistant professor of pediatrics at Saint Louis University and a pediatric intensivist at Cardinal Glennon Children’s Hospital, St Louis, Missouri. Charlene P Leonard is a nurse practitioner in pediatric critical care medicine, University of Florida and UFHealth Shands Children’s Hospital, Gainesville, Florida. Sharon L. Leslie is a nursing informationist at Woodruff Health Sciences Center Library, Emory University. Christine Allen is associate professor of pediatrics at the Children’s Hospital of Oklahoma/University of Oklahoma, Oklahoma City, Oklahoma. Vijay Srinivasan is an assistant professor of anesthesiology, critical care, and pediatrics at Perelman School of Medicine at the University of Pennsylvania and a pediatric intensivist in the Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Sharon Y. Irving is an assistant professor of pediatric nursing at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, and a nurse practitioner in pediatric intensive and progressive care at Children’s Hospital of Philadelphia.

Search for other works by this author on:

This Site

PubMed

Google Scholar

Charlene P. Leonard, MSN, CPNP-AC/PC;

Charlene P. Leonard, MSN, CPNP-AC/PC

Ann-Marie Brown is an assistant clinical professor at Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a nurse practitioner in pediatric intensive care at Akron Children’s Hospital, Akron, Ohio. Erik C. Madsen is an assistant professor of pediatrics at Saint Louis University and a pediatric intensivist at Cardinal Glennon Children’s Hospital, St Louis, Missouri. Charlene P Leonard is a nurse practitioner in pediatric critical care medicine, University of Florida and UFHealth Shands Children’s Hospital, Gainesville, Florida. Sharon L. Leslie is a nursing informationist at Woodruff Health Sciences Center Library, Emory University. Christine Allen is associate professor of pediatrics at the Children’s Hospital of Oklahoma/University of Oklahoma, Oklahoma City, Oklahoma. Vijay Srinivasan is an assistant professor of anesthesiology, critical care, and pediatrics at Perelman School of Medicine at the University of Pennsylvania and a pediatric intensivist in the Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Sharon Y. Irving is an assistant professor of pediatric nursing at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, and a nurse practitioner in pediatric intensive and progressive care at Children’s Hospital of Philadelphia.

Search for other works by this author on:

This Site

PubMed

Google Scholar

Sharon L. Leslie, MSLS, AHIP;

Sharon L. Leslie, MSLS, AHIP

Ann-Marie Brown is an assistant clinical professor at Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a nurse practitioner in pediatric intensive care at Akron Children’s Hospital, Akron, Ohio. Erik C. Madsen is an assistant professor of pediatrics at Saint Louis University and a pediatric intensivist at Cardinal Glennon Children’s Hospital, St Louis, Missouri. Charlene P Leonard is a nurse practitioner in pediatric critical care medicine, University of Florida and UFHealth Shands Children’s Hospital, Gainesville, Florida. Sharon L. Leslie is a nursing informationist at Woodruff Health Sciences Center Library, Emory University. Christine Allen is associate professor of pediatrics at the Children’s Hospital of Oklahoma/University of Oklahoma, Oklahoma City, Oklahoma. Vijay Srinivasan is an assistant professor of anesthesiology, critical care, and pediatrics at Perelman School of Medicine at the University of Pennsylvania and a pediatric intensivist in the Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Sharon Y. Irving is an assistant professor of pediatric nursing at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, and a nurse practitioner in pediatric intensive and progressive care at Children’s Hospital of Philadelphia.

Search for other works by this author on:

This Site

PubMed

Google Scholar

Christine Allen, MD;

Christine Allen, MD

Ann-Marie Brown is an assistant clinical professor at Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a nurse practitioner in pediatric intensive care at Akron Children’s Hospital, Akron, Ohio. Erik C. Madsen is an assistant professor of pediatrics at Saint Louis University and a pediatric intensivist at Cardinal Glennon Children’s Hospital, St Louis, Missouri. Charlene P Leonard is a nurse practitioner in pediatric critical care medicine, University of Florida and UFHealth Shands Children’s Hospital, Gainesville, Florida. Sharon L. Leslie is a nursing informationist at Woodruff Health Sciences Center Library, Emory University. Christine Allen is associate professor of pediatrics at the Children’s Hospital of Oklahoma/University of Oklahoma, Oklahoma City, Oklahoma. Vijay Srinivasan is an assistant professor of anesthesiology, critical care, and pediatrics at Perelman School of Medicine at the University of Pennsylvania and a pediatric intensivist in the Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Sharon Y. Irving is an assistant professor of pediatric nursing at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, and a nurse practitioner in pediatric intensive and progressive care at Children’s Hospital of Philadelphia.

Search for other works by this author on:

This Site

PubMed

Google Scholar

Vijay Srinivasan, MBBS, MD;

Vijay Srinivasan, MBBS, MD

Ann-Marie Brown is an assistant clinical professor at Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a nurse practitioner in pediatric intensive care at Akron Children’s Hospital, Akron, Ohio. Erik C. Madsen is an assistant professor of pediatrics at Saint Louis University and a pediatric intensivist at Cardinal Glennon Children’s Hospital, St Louis, Missouri. Charlene P Leonard is a nurse practitioner in pediatric critical care medicine, University of Florida and UFHealth Shands Children’s Hospital, Gainesville, Florida. Sharon L. Leslie is a nursing informationist at Woodruff Health Sciences Center Library, Emory University. Christine Allen is associate professor of pediatrics at the Children’s Hospital of Oklahoma/University of Oklahoma, Oklahoma City, Oklahoma. Vijay Srinivasan is an assistant professor of anesthesiology, critical care, and pediatrics at Perelman School of Medicine at the University of Pennsylvania and a pediatric intensivist in the Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Sharon Y. Irving is an assistant professor of pediatric nursing at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, and a nurse practitioner in pediatric intensive and progressive care at Children’s Hospital of Philadelphia.

Search for other works by this author on:

This Site

PubMed

Google Scholar

Sharon Y. Irving, PhD, CRNP

Ann-Marie Brown is an assistant clinical professor at Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a nurse practitioner in pediatric intensive care at Akron Children’s Hospital, Akron, Ohio. Erik C. Madsen is an assistant professor of pediatrics at Saint Louis University and a pediatric intensivist at Cardinal Glennon Children’s Hospital, St Louis, Missouri. Charlene P Leonard is a nurse practitioner in pediatric critical care medicine, University of Florida and UFHealth Shands Children’s Hospital, Gainesville, Florida. Sharon L. Leslie is a nursing informationist at Woodruff Health Sciences Center Library, Emory University. Christine Allen is associate professor of pediatrics at the Children’s Hospital of Oklahoma/University of Oklahoma, Oklahoma City, Oklahoma. Vijay Srinivasan is an assistant professor of anesthesiology, critical care, and pediatrics at Perelman School of Medicine at the University of Pennsylvania and a pediatric intensivist in the Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Sharon Y. Irving is an assistant professor of pediatric nursing at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, and a nurse practitioner in pediatric intensive and progressive care at Children’s Hospital of Philadelphia.

Search for other works by this author on:

This Site

PubMed

Google Scholar

Am J Crit Care (2020) 29 (1): 33–45.

https://doi.org/10.4037/ajcc2020850

Background

Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings.

Objective

To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improve nutrition delivery in critically ill children receiving mechanical ventilation.

Methods

Five hundred seventy-nine abstracts met the inclusion criteria and were screened by 2 reviewers according to prespecified criteria. Full-text reviews were performed on 28 articles; 11 studies were selected for detailed analysis. Because of the small number of eligible studies, broader searches were conducted.

Results

Only 5 studies with a collective enrollment of fewer than 200 children closely addressed the specific research question. These 5 studies did not report any similarity in feeding regimens, nor did they report nutritional outcomes. Two of the articles described findings from the same study population. Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis.

Conclusions

The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation.

2020

You do not currently have access to this content.

Don't already have an account? Register

Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review

Cited By

Email alerts

JOURNALS

Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review

Sign in

AACN Account

Sign in via your Institution

Subscribe

Short-term Access

Cited By

Email alerts

JOURNALS

This Feature Is Available To Subscribers Only