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Gambaran umum berbagai faktor keterlambatan pemberian nutrisi enteral pada pasien anak di Ruang Rawat Intensif Anak, RSUP Sanglah, Denpasar, Bali

  • Ni Luh Sri Apsari ,
  • I Gusti Lanang Sidiartha ,
  • I Nyoman Budi Hartawan ,
  • Dyah Kanya Wati ,
  • Ida Bagus Gede Suparyatha ,


Abstract

Background: Enteral nutrition is the primary choice in pediatric patients who do not experience gastrointestinal disorders. Many factors inhibit the achievement of enteral nutrition in pediatric patients treated in intensive care. This study aims to determine the overview of various factors that may result in delays enteral nutrition administration in critically ill pediatric patients

Methods: An observational cross-sectional analytic study was carried out on secondary data of medical records among children who were treated in pediatric intensive care unit at Sanglah Hospital throughout 2016. Delay in enteral nutrition was assessed if there was enteral nutrition administration more than 2x24 hours since first admission. Factors assessed include gender, age, PELOD, diagnosis, invasive breathing aids, impaired motility, gastrointestinal bleeding, and hemodynamic instability. Data were analyzed using the SPSS version 20 software program whereas P value <0.05 was considered statistically significant.

Results: From the 115 samples, there were 69 (60%) males and 46 (40%) females. About 50 samples (43,5%) experienced delayed enteral nutrition. Significant variables related to the delay in enteral nutrition after multivariate analysis were gastrointestinal motility disorders (p = 0,004, OR 9,082, 95% IK 2,827 – 29,171), and gastrointestinal bleeding (p = 0,0001; OR 14,317; IK 95 % 4,087 – 50,155).

Conclusion Intestinal motility disorders and gastrointestinal bleeding are known as a contributing factor in the delay of enteral nutrition administration in PICU Sanglah Hospital, Denpasar, Bali.
Keywords: early enteral nutrition critically ill children motility disturbance gastrointestinal bleeding

References

  1. Briassoulis G, Zavras N, Hatzis T. Malnutrition, Nutritional Indices, and Early Enteral Feeding in Critically Ill Children Malnutrition. Nutrition 2001; 17(7-8):548 –57.
  2. Mikhailov TA, Kuhn EM, Manzi J, Christensen M, Collins M, Brown AM, Dechert R, Scanlon MC, Wakeham MK, Goday PS. Early Enteral Nutrition Is Associated With Lower Mortality in Critically Ill Children. JPEN J Parenter Enteral Nutr 2014; 38(4):459-66.
  3. Mehta NM, Bechard LJ, Cahill N, Wang M, Day A, Duggan CP, Heyland DK. Nutritional practices and their relationship to clinical outcomes in critically ill children--an international multicenter cohort study. Crit Care Med. 2012; 40(7):2204–11.
  4. Mehta NM, Compher C, A.S.P.E.N. Board of Directors. A.S.P.E.N. Clinical Guidelines: Nutrition Support of the Critically Ill Child. JPEN J Parenter Enteral Nutr. 2009; 33(3):260-76.
  5. Mehta NM, McAleer D, Hamilton S, et al. Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit. JPEN J Parenter Enteral Nutr 2010; 34(1):38–45.
  6. Canarie MF, Barry S, Carrol LC, Hassinger A, Kandil S, Li S, Pinto M, Valentine SL, Faustino EVS, Northeast Pediatric Critical Care Research Consortium. Risk Factors for Delayed Enteral Nutrition in Critically Ill Children. Pediatr Crit Care Med. 2015; 16(8): e283-9
  7. Hamilton S, McAleer D, Ariagno K, Stenquist N, Duggan CP, Mehta NM. A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals. Pediatr Crit Care Med. 2014; 15(7):583–9.
  8. Rogers EJ, Gilbertson HR, Heine RG, Henning R. Barriers to adequate nutrition in critically ill children. Nutrition. 2003; 19(10):865–8.
  9. Lee H, Koh SO, Kim H, Sohn MH, Kim KE, Kim KW. Avoidable cause of delayed enteral nutrition in critically ill children. J Korean Med Sci 2013; 28(7):1055-9.
  10. Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004; 20(10):843-8.
  11. Mazuski JE. Feeding the injured intestine: enteral nutrition in the critically ill patient. Curr Opin Crit Care. 2008; 14(4):432-7.
  12. Zambelan P, Delgado AF, Leone C, Feferbaum R, Okay TS. Nutrition Therapy in a Pediatric Intensive care Unit: Indication, monitoring, and complication. JPEN J Parenter Enteral Nutr 2001;35:523-9
  13. Skillman HE, Mehta NM. Nutrition therapy in the critically ill child. Curr Opin Crit Care. 2012; 18(2):192-8
  14. Briassoulis GC, Tsorva A, Zavras N, Hatzis T. Influence of an aggres¬sive early enteral nutrition protocol on nitrogen balance in criti¬cally ill children. J Nutr Biochem 2002; 13(9):560
  15. Mutlu GM, Mutlu EA, Factor P. Prevention and treatment of gastrointestinal complication in patient on mechanical ventilation. Am J Respir Med 2003; 2(5):395-411
  16. Jacobs S, Chang RWS, Lee B, Bartlett FW. Continous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients. JPEN Parenter Enteral Nutr 1990;14(4):353-6.
  17. Albert BD, Zurakowski D, Bchard LJ, Priebe GP, Duggan CP, Heyland DK. Enteral nurition and acid suppressive therapy in the pediatric intensive care unit: impact on the risk of ventilator-associated pneumonia. Pediatr Crit Care Med. 2016;17(10):924-9.
  18. O’Meara D, Mireles-Cabodevila E, Frame F, Hummell C, Hammell J, Dweik RA, Arroliga AC. Evaluation of delivery of enteral nutrition in critically ill patients receivingmechanical ventilation. Am J Crit Care 2008; 17(1):53-61.
  19. Leong AY, Cartwright KR, Guerra GG, et al. A Canadian survey of perceived barriers to initiation and continuation of enteral feeding in PICUs. Pediatr Crit Care Med 2014; 15(2):e49–55.
  20. Heyland DK, Drover JW, Dhaliwal R, Greenwood J. Optimizing the benefits and minimizing risk of enteral nutrition in the critically ill: role of small bowel feeding. JPEN J Parenter Enteral Nutr. 2002;26(6):51-7.
  21. Jacobs DG, Jacobs DO, Kudsk KA, Moore FA, Oswanski MF, Poole GV et al. Practice management guidelines for nutritional support of the trauma patient. J Trauma. 2004; 57(3):660-78
  22. Chu Y, Jiang Y, Meng M, Jiang J, Zhang J, Ren H, Wang CT. Incidence and risk factors of gastrointestinal bleeding in mechanically ventilated patients. World J Emerg Med 2010;1(1):32-6.
  23. Leyba OC, González JC, Alonso VC. Guide- lines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): patient with sepsis. Med Intensiva 2011; 35(1):72-6.
  24. Yang S, Wu X, Yu w, Li J. Early nutrition in critically ill patients with hemodynamic instability: an evidence-based review and practical advice. Nutr Clin Pract 2014; 29(1):90-97.
  25. Wells DL. Provision of enteral nutrition durng vasopressor therapy for hemodynamic instability: an evidence-based review. Nutr Clin Pract 2012; 27(4):521-6.

How to Cite

Apsari, N. L. S., Sidiartha, I. G. L., Hartawan, I. N. B., Wati, D. K., & Suparyatha, I. B. G. (2019). Gambaran umum berbagai faktor keterlambatan pemberian nutrisi enteral pada pasien anak di Ruang Rawat Intensif Anak, RSUP Sanglah, Denpasar, Bali. Intisari Sains Medis, 10(2). https://doi.org/10.15562/ism.v10i2.314
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Ni Luh Sri Apsari
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I Gusti Lanang Sidiartha
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I Nyoman Budi Hartawan
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Dyah Kanya Wati
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Ida Bagus Gede Suparyatha
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