Enteral hydration in high-flow therapy for infants with bronchiolitis: Secondary analysis of a randomised trial.

Franz E Babl, Donna Franklin, Luregn J Schlapbach, Ed Oakley, Stuart Dalziel, Jennifer A Whitty, Jocelyn Neutze, Jeremy Furyk, Simon Craig, John F Fraser, Mark Jones, Andreas Schibler

Journal: Journal of paediatrics and child health 2021;56(6):950-955

PMID: 32043304

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Abstract

AIM

Nasal high-flow oxygen therapy is increasingly used in infants for supportive respiratory therapy in bronchiolitis. It is unclear whether enteral hydration is safe in children receiving high-flow.

METHODS

We performed a planned secondary analysis of a multi-centre, randomised controlled trial of infants aged <12 months with bronchiolitis and an oxygen requirement. Children were assigned to treatment with either high-flow or standard-oxygen therapy with optional rescue high-flow. We assessed adverse events based on how children on high-flow were hydrated: intravenously (IV), via bolus or continuous nasogastric tube (NGT) or orally.

RESULTS

A total of 505 patients on high-flow via primary study assignment (n = 408), primary treatment (n = 10) or as rescue therapy (n = 87) were assessed. While on high flow, 15 of 505 (3.0%) received only IV fluids, 360 (71.3%) received only enteral fluids and 93 (18.4%) received both IV and enteral fluids. The route was unknown in 37 (7.3%). Of the 453 high-flow infants hydrated enterally patients could receive one or more methods of hydration; 80 (15.8%) received NGT bolus, 217 (43.0%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral hydration and 171 (33.9%) a mix of NGT and oral hydration. None of the patients receiving oral or NGT hydration on high-flow sustained pulmonary aspiration (0%; 95% confidence interval N/A); one patient had a pneumothorax (0.2%; 95% confidence interval 0.0-0.7%).

CONCLUSIONS

The vast majority of children with hypoxic respiratory failure in bronchiolitis can be safely hydrated enterally during the period when they receive high-flow.

Address: Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.; Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.; Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.; Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.; Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.; Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.; Liggins Institute, University of Auckland, Auckland, New Zealand.; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.; Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand.; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.; Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.; Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.; Paediatric Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.; School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.

DOI: 10.1111/jpc.14799

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MeSH Terms: Aged, Bronchiolitis, Humans, Infant, Intubation, Gastrointestinal, Length of Stay, Oxygen, Oxygen Inhalation Therapy