Enteral hydration in high-flow therapy for infants with bronchiolitis: secondary analysis of a randomised trial

Babl, Franz E., Franklin, Donna, Schlapbach, Luregn J., Oakley, Ed, Dalziel, Stuart, Whitty, Jennifer A., Neutze, Jocelyn, Furyk, Jeremy, Craig, Simon, Fraser, John F., Jones, Mark, Schibler, Andreas, PREDICT, , and PCCRG, (2020) Enteral hydration in high-flow therapy for infants with bronchiolitis: secondary analysis of a randomised trial. Journal of Paediatrics and Child Health, 56 (6). pp. 950-955.

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Abstract

Aim Nasal high-flow oxygen therapy is increasingly used in infants for supportive respiratory therapy in bronchiolitis. It is unclear whether enteral hydration is safe in children receiving high-flow.

Methods We performed a planned secondary analysis of a multi-centre, randomised controlled trial of infants aged <12 months with bronchiolitis and an oxygen requirement. Children were assigned to treatment with either high-flow or standard-oxygen therapy with optional rescue high-flow. We assessed adverse events based on how children on high-flow were hydrated: intravenously (IV), via bolus or continuous nasogastric tube (NGT) or orally.

Results A total of 505 patients on high-flow via primary study assignment (n = 408), primary treatment (n = 10) or as rescue therapy (n = 87) were assessed. While on high flow, 15 of 505 (3.0%) received only IV fluids, 360 (71.3%) received only enteral fluids and 93 (18.4%) received both IV and enteral fluids. The route was unknown in 37 (7.3%). Of the 453 high-flow infants hydrated enterally patients could receive one or more methods of hydration; 80 (15.8%) received NGT bolus, 217 (43.0%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral hydration and 171 (33.9%) a mix of NGT and oral hydration.

None of the patients receiving oral or NGT hydration on high-flow sustained pulmonary aspiration (0%; 95% confidence interval N/A); one patient had a pneumothorax (0.2%; 95% confidence interval 0.0-0.7%).

Conclusions The vast majority of children with hypoxic respiratory failure in bronchiolitis can be safely hydrated enterally during the period when they receive high-flow.

Item ID: 62392
Item Type: Article (Research - C1)
ISSN: 1440-1754
Keywords: bronchiolitis, enteral hydration, high-flow
Copyright Information: © 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
Funders: National Health and Medical Research Council (NHMRC), Emergency Medicine Foundation (EMF), Ipswich Hospital Foundation, Gold Coast University Hospital Foundation (GCUHF), Queensland Health (QH), Victorian Government (VG), Royal Children's Hospital Foundation (RCHF), Health Research Council of New Zealand (HRCNZ), Queensland Government (QG), Fisher & Paykel Healthcare (F&P)
Projects and Grants: NHMRC GNT1081736, QH Research Fellowship, NHMRC Centre of Research Excellence GNT1058560, VG Infrastructure Support Program, RCHF Fellowship, NHMRC Practitioner Fellowship, QC SERTA grant (Study, Education and Research Trust Account), F&P Research Grant
Date Deposited: 04 Mar 2020 07:36
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320207 Emergency medicine @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3213 Paediatrics > 321302 Infant and child health @ 50%
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