Feeding Practices of Paediatric Patients Aged One Month to Fifty-nine Months Admitted Into the Intensive Care Units (Icus) of Kenyatta National Hospital and Factors Associated With Initiation of Feeds Beyond the First 48 Hours of Icu Admission: (a Prospective Cohort Study)

Abstract

Background: Malnutrition occurs in critically ill children in both Low- and High-Income Countries. Feeding practices during Intensive Care Unit (ICU) admission may contribute to the development of malnutrition. Malnutrition has been associated with increased length of ICU stay, length of time on the ventilator and mortality. Although provision of adequate nutrition is an important aspect of patient management in the ICU, many critically ill children are unable to feed orally. Enteral feeding is therefore provided as an alternative to oral feeding. Early enteral feeding is feeding within the first 24-48 hours of ICU admission and has been associated with reduced length of Intensive Care Unit stay, hospital stay and mortality. Research on feeding practices in critically ill children around the world is limited, particularly in low-Income countries. This study aims to add to the body of literature by describing the enteral feeding practices of children admitted to Kenyatta National Hospital. Findings of this study will help inform clinical practice and guidelines in Kenya and other parts of Africa. The primary aim of the study is: To determine the proportion of Pediatric patients admitted to the Intensive Care Units of Kenyatta National Hospital who have their first feed initiated within the first 48 hours of admission. The secondary aims are: i) To determine the factors associated with initiation of enteral feeds beyond 48hours of ICU admission and withholding of feeds in paediatric patients admitted to the Intensive Care Units of Kenyatta National Hospital. ii)To determine the percentage of paediatric patients who experience complications associated with enteral nutrition, and the factors associated with complications of enteral nutrition. iii) To compare outcomes of children admitted to the intensive care units of Kenyatta National Hospital with timing of initiation of enteral nutrition. Methodology: This was a prospective longitudinal study conducted at Kenyatta National Hospital Paediatric Intensive Care Unit (PICU), Main Critical Care Unit (CCU) and Cardiothoracic Critical Care Unit. Children between the ages of 1 month and 59 months will be eligible for the study. Data from the patients’ notes will be captured on data collection forms and electronically using REDCap. Data collected at baseline will include age, sex, admitting diagnosis, date and time of admission, ventilatory support and type, inotropic support and dose, 11 Paediatric Logistic Organ Dysfunction (PELOD) score and mid-upper arm circumference (MUAC). Data will be collected daily for the first 7 days of admission, to determine time in hours from admission to initiation of first feed, time to reach full volume feed, complications associated with feeding, timing of complications, reason for feed being withheld or discontinued. Patients will be followed up till death or discharge from the ICU. The data will be analysed using R version 4.1.2.