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A randomised prospective trial to compare the efficacy of bolus versus continuous nasogastric feeding in paediatric intensive care

Introduction

Failure to establish early nasogastric (NG) feeding is common in paediatric intensive care (PIC) and influences the outcome. Decreased gastrointestinal motility is multifactorial in origin. NG feeds may be administered continuously or by intermittent bolus; we hypothesise that bolus enteral feeds are more physiological when compared with continuous NG feeds. We aimed to compare bolus versus continuous NG feeding in PIC. The outcome measures were the time to achieve maximal nutritional requirement by volume of feed and to identify the frequency of adverse events.

Methods

Following ethical approval and informed consent, eligible admissions to a tertiary PIC from April 2006 to February 2008 were prospectively randomised and enrolled into the study. Gastrostomy feeding, use of motility drugs, gastroesophageal reflux and gastrointestinal surgery were the exclusion criteria. Patients were randomised to receive either 3-hourly bolus feeds or continuous feeding over 21 hours per day, for a 48-hour study period. NG tubes were aspirated 3-hourly and the gastric residual volume was recorded. The protocol was designed to give equal feed volume in a 24-hour period. Intolerance was defined as gastric residual volume more than 125% of feed administered. Data are expressed as the median (interquartile range). Mann–Whitney's test and Fisher's exact test were used to test for associations.

Results

Seventy-six patients were enrolled (1.2:1, male:female), median age 11.6 (2.8 to 49.0) months and weight 10 (4.5 to 16.2) kg. Bolus group subjects achieved maximal feed potential by 21 hours (95% CI = 18.6 to 25), the continuous group required 27 hours (95% CI = 19.5 to 30, P = 0.035). The demographic characteristics, sedation, muscle relaxant or inotrope usage between groups were comparable. There was no statistically significant difference in the incidence of adverse events (bolus n = 3 and continuous n = 4, P = 0.71).

Conclusion

This is the first study comparing enteral feeding techniques in PIC patients. In PIC, bolus feeding methods may be more beneficial, in achieving maximal nutritional requirements earlier, when compared with continuous feeds. The risk of aspiration of aspiration or vomiting is low with both feeding techniques.

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Kamath, P., Longden, J., Stack, C. et al. A randomised prospective trial to compare the efficacy of bolus versus continuous nasogastric feeding in paediatric intensive care. Crit Care 13, P142 (2009). https://doi.org/10.1186/cc7306

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Keywords

  • Intermittent Bolus
  • Nasogastric Feeding
  • Gastric Residual Volume
  • Feeding Technique
  • Gastrostomy Feeding