Enteral feeding intolerance: an indicator of sepsis-associated mortality in burned children
S. E. Wolf, M. G. Jeschke, J. K. Rose, M. H. Desai and D. N. Herndon
Department of Surgery, University of Texas Medical Branch and the Shriners Burn Institute, Galveston 77550, USA. swolf@sbi.utmb.edu
OBJECTIVE: To determine if enteral feeding intolerance (EFI) is associated
with sepsis and increased mortality in children with severe burns. DESIGN:
A survey. SETTING: A pediatric burn unit. PATIENTS: Ninety-one children
surviving longer than 5 days with greater than 80% total body surface area
burns. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Enteral feeding
intolerance indicated by high gastric residuals (> 150 mL/h) or
uncontrollable diarrhea (> 2500 mL/d); thrombocytopenia (platelet count
< 100 x 10(9)/L); hyperglycemia (glucose level > 11.1 mmol/L [>
200 mg/dL]); sepsis (pathogenic bacteremia or fungemia noted on blood
culture results); and mortality. RESULTS: Neither EFI nor sepsis developed
in 71 patients, EFI alone developed in 2 patients, sepsis alone developed
in 5 patients, and EFI and sepsis developed in 13 patients. Enteral feeding
intolerance and sepsis were associated by contingency table analysis
(P<.001). Mortality was 8% (6 patients) in those with neither EFI nor
sepsis, 50% (1 patient) in those with EFI alone, 60% (3 patients) in those
with sepsis alone, and 77% (10 patients) in those with EFI-associated
sepsis. The 2 latter groups were different from the group with neither EFI
nor sepsis (P<.05). Enteral feeding intolerance was identified in 70% of
patients before sepsis; thrombocytopenia, 64%; and hyperglycemia, 66%. When
compared with thrombocytopenia and hyperthermia, no variables were found to
be superior to others for predicting sepsis. CONCLUSIONS: Enteral feeding
intolerance was associated with the development of sepsis and increased
mortality in children with greater than 80% total body surface area burns.
This sign was identified in 70% of the cases before pathogens were found in
the blood; no difference could be shown between the identification of EFI,
thrombocytopenia, and hyperglycemia before sepsis. These data indicate that
the development of EFI should be used as an indicator of infection and
should prompt a search for an inciting focus.
