PC3090: Safety and Efficacy of Enteral Feeding on High Flow Nasal Cannula in Bronchiolitis Patients

Background: Guidelines for enteral feeding on high-flow nasal cannula (HFNC) in hospitalized bronchiolitis patients are lacking. Our primary objective was to evaluate adverse events with enteral feeding on HFNC and secondary objective was to assess association of enteral feeding on HFNC with nutritional and clinical outcomes.

Methods: Single center retrospective review of all hospitalized bronchiolitis patients ≤ 24 months of age managed with HFNC from January 2014 to December 2019. Demographics, severity of illness, level of HFNC ( < 1L/kg/min, 1-2L/kg/min and >2L/kg/min), enteral feeding on HFNC, adverse events (AE) (aspiration pneumonia, episodes of emesis and escalation of respiratory support), nutritional outcomes (achievement of nutritional volume and caloric goals, weight loss/gain), and clinical outcomes (duration of HFNC and oxygen supplementation following HFNC, length of hospital stay, emergency visits and hospital readmissions after discharge) were studied. Statistical analysis included Wilcoxon rank sum test for continuous/ordinal variables and Pearson’s chi-square or Fisher’s exact test for categorical values. All tests were two-tailed.

Results: 205 patients with median age of 7 months [2, 16] and median weight of 7.8 kg [5, 10.3] were studied. 139 patients on < 1L/kg/min HFNC level (78 fed and 61 non-fed), 62 patients on 1-2L/kg/min HFNC level (22 fed and 40 non-fed) and 4 patients on >2L/kg/min HFNC level (1 fed and 3 non-fed) were studied. There was no significant differences in demographics, severity of illness, type of viral infection, and co-morbidities among fed and non-fed patients. Bronchiolitis patients fed on HFNC had significantly less AE than non-fed patients (≥ 1 AE: 7.9% vs 37.5%, p < 0.001). Fed patients compared to non-fed did not have statistically significant aspiration pneumonia episodes (3% vs 0%, p=0.12), but had more episodes of emesis (3.9% vs 0%, p=0.043) and significantly less episodes of escalation of respiratory support (2% vs 37.5%, p< 0.001). Fed patients compared to non-fed had earlier initiation of enteral feeding from admission (10 hours [2, 19] vs 20 hours [11,37], p< 0.001), earlier achievement of nutritional volume (2 days [1, 3] vs 2 days [2,4], p< 0.001), earlier achievement of caloric goals (2 days [1, 3] vs 2 days [2,4], p=0.004), and greater weight gain from admission to discharge (0, [0, 1] vs 0 [-2, 0], p=0.058) (Figure 1). Fed patients compared to non-fed had significantly shorter duration of oxygen supplementation after HFNC, longer duration of HFNC support, significantly shorter length of hospital stay without an increase in emergency visits or hospital readmissions after discharge (Table 1).

Conclusion: Our study reveals enteral feeding is safe in bronchiolitis patients managed at different levels of HFNC. Additionally, initiation of feeding in bronchiolitis patients on HFNC facilitated earlier achievement of nutritional goals and improved clinical outcomes without an increase of emergency visits or hospital readmissions after discharge.