Enteral Feeding of Children on Noninvasive Respiratory Support: A Four-Center European Study∗

Objectives: To explore enteral feeding practices and the achievement of energy targets in children on noninvasive respiratory support, in four European PICUs. Design: A four-center retrospective cohort study. Setting: Four PICUs: Bristol, United Kingdom; Lyon, France; Madrid, Spain; and Rotterdam, The Netherlands. Patients: Children in PICU who required acute noninvasive respiratory support in the first 7 days. The primary outcome was achievement of standardized kcal/goal. Interventions: None. Measurements and Main Results: A total of 325 children were included (Bristol 104; Lyon 99; Madrid 72; and Rotterdam 50). The median (interquartile range) age and weight were 3 months (1-16 mo) and 5 kg (4-10 mo), respectively, with 66% admitted with respiratory failure. There were large between-center variations in practices. Overall, 190/325 (58.5%) received noninvasive respiratory support in order to prevent intubation and 41.5% after extubation. The main modes of noninvasive respiratory support used were high-flow nasal cannula 43.6%, bilevel positive airway pressure 33.2%, and continuous positive airway pressure 21.2%. Most children (77.8%) were fed gastrically (48.4% continuously) and the median time to the first feed after noninvasive respiratory support initiation was 4 hours (interquartile range, 1-9 hr). The median percentage of time a child was nil per oral while on noninvasive respiratory support was 4 hours (2-13 hr). Overall, children received a median of 56% (25-82%) of their energy goals compared with a standardized target of 0.85 of the recommended dietary allowance. Patients receiving step-up noninvasive respiratory support (p = < 0.001), those on bilevel positive airway pressure or continuous positive airway pressure (compared with high-flow nasal cannula) (p = < 0.001), and those on continuous feeds (p = < 0.001) achieved significantly more of their kcal goal. Gastrointestinal complications varied from 4.8 - 20%, with the most common reported being vomiting in 54/325 (16.6%), other complications occurred in 40/325 (12.3%) children, but pulmonary aspiration was rare 5/325 (1.5%). Conclusions: Children on noninvasive respiratory support tolerated feeding well, with relatively few complications, but prospective trials are now required to determine the optimal timing and feeding method for these children

Salivary cholesterol level does not reflect cholesterolemia in children with heterozygous familial hypercholesterolemia

International audienceObjectivesHeterozygous familial hypercholesterolemia is a common genetic disease responsible for premature atherosclerosis. Therefore, early diagnosis and treatment are recommended to reduce cardiovascular risk. Usually, the screening is based on high plasma LDL-cholesterol. In children, blood testing is often an obstacle for screening. This study aims to evaluate the relevance of a salivary non-invasive LDL dosage in heterozygous familial hypercholesterolemia in a pediatric population.Materials and methodsProspective, case control, monocentric study comparaing the salivary cholesterol of 30 heterozygous familial hypercholesterolemia pediatric patients and 30 healthy age-matched controls with two different enzymatic kits (Amplite™ kit - AAT Bioquest® and Total Cholesterol Assay kit - CELL BIOLABS®, Inc).ResultsWhile the median serum total-cholesterol was significantly different in control and heterozygous familial hypercholesterolemia patients as expected, the median salivary cholesterol concentration was similar between the two groups and 1000 times lower than in serum. No correlation was found between salivary and serum cholesterol concentrations.ConclusionAlthough cholesterol is detectable in saliva, our study suggests that the low salivary cholesterol concentrations result mostly from variable gingival bleeding, precluding any reliable use for Heterozygous Familial Hypercholesterolemia screening in children.But/ObjectifL’hypercholestérolémie familiale est une maladie génétique fréquente responsable de lésion d’athérosclérose précoce. Ainsi, le diagnostic et le traitement précoce sont recommandés pour réduire le risque cardiovasculaire. Le dépistage actuellement recommandé est réalisé par le dosage sanguin de LDL-cholestérol. Chez l’enfant, le caractère invasif des prises de sang peut être un obstacle à la réalisation du dépistage. Cette étude a pour but d’évaluer la pertinence du dosage salivaire non invasif du LDL-cholestérol chez les enfants atteints d’hypercholestérolémie familiale.Matériels et méthodesÉtude prospective, cas-contrôle, monocentrique comparant le cholestérol salivaire chez 30 enfant témoins et chez 30 enfants hypercholestérolémiques apparié en age dosé par deux kits enzymatiques (Amplite™ kit - AAT Bioquest® et Total Cholesterol Assay kit - CELL BIOLABS®, Inc)RésultatsLe cholestérol total sérique médian est significativement différent entre les deux groupes comme attendu, néanmoins les taux médians de cholestérol salivaire sont similaires entre les deux groupes et 1000 fois inférieures au sérum. Aucune corrélation n’a été retrouvée entre la salive et le cholestérol total sérique.ConclusionLe cholestérol total est bien détectable dans la salive, notre étude suggère que le faible taux de cholestérol dans la salive résulte en majeur parti d’une contamination par micro-saignement gingival, ne permettant pas de l’envisager comme un outil fiable non invasif pour le dépistage de l’hypercholestérolémie familiale chez l’enfant