Neurocritical Care

, Volume 30, Issue 1, pp 193–200 | Cite as

Enteral Nutrition Initiation in Children Admitted to Pediatric Intensive Care Units After Traumatic Brain Injury

  • Binod BalakrishnanEmail author
  • Katherine T. Flynn-O’Brien
  • Pippa M. Simpson
  • Mahua Dasgupta
  • Sheila J. Hanson
Original Article



Traumatic brain injury (TBI) is the leading cause of death and long-term disability among injured children. Early feeding has been shown to improve outcomes in adults, with some similar evidence in children with severe TBI. We aimed to examine the current practice of initiation of enteral nutrition in children with TBI and to evaluate the risk factors associated with delayed initiation of enteral nutrition.


This retrospective, multicenter study used the Pediatric Trauma Assessment and Management Database including all children with head trauma discharged from five pediatric intensive care units (PICU) at pediatric trauma centers between January 1, 2013 and December 31, 2013. We compared demographics, injury and procedure data, time to initiation of nutrition, and injury and illness severity scores between patients who received enteral nutrition early (≤ 48 h) and late (> 48 h). Fisher’s exact and Mann–Whitney U tests compared discrete and continuous variables. Univariate and multivariable analyses evaluated variables associated with delayed initiation of feeding. Outcomes of interest included mortality, complications, ventilator days, hospital and ICU length of stay, and functional status at ICU discharge.


In the 416 patients in the study, the overall mortality was 2.6%. The majority of patients (83%; range 69–88% between five sites, p = 0.0008) received enteral nutrition within 48 h of PICU admission. Lower Glasgow Coma Scale scores and higher Injury Severity Score (ISS) were independently associated with delayed initiation of enteral nutrition. Delayed enteral nutrition was independently associated with worse functional status at PICU discharge (p = 0.02) but was not associated with mortality or increased length of stay.


Children with severe TBI and higher ISS were more likely to have delayed initiation of enteral nutrition. Delayed enteral nutrition was an independent risk factor for worse functional status at ICU discharge for the entire cohort, but not for the severe TBI group.


Traumatic brain injury Children Pediatric intensive care Enteral nutrition Outcomes Trauma Pediatric 


Author Contribution

Dr. Balakrishnan conceptualized the study, interpreted the data analysis, wrote the first draft and edited the manuscript. Dr. Flynn-O’Brien created the PTAM database used for the study and was involved in data interpretation and manuscript edits. Dr. Simpson and Ms. Dasgupta provided statistical data analysis and edited the manuscript. Dr. Hanson conceptualized the study, interpreted the data analysis and edited the manuscript.

Source of support

This project was, in part, supported by a 2014 Childress Foundation grant. Dr. Katherine T Flynn-O’Brien received fellowship support from the National Institute of Child Health and Human Development (T32-HD057822) during the preparation of this paper. VPS data were provided from the VPS, LLC. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Childress Institute, or VPS, LLC.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Supplementary material

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Supplementary material 1 (DOCX 15 kb)
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Supplementary material 2 (DOCX 14 kb)
12028_2018_597_MOESM3_ESM.docx (14 kb)
Supplementary material 3 (DOCX 13 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Binod Balakrishnan
    • 1
    Email author
  • Katherine T. Flynn-O’Brien
    • 2
  • Pippa M. Simpson
    • 3
  • Mahua Dasgupta
    • 3
  • Sheila J. Hanson
    • 1
  1. 1.Division of Critical Care, Department of PediatricsChildren’s Hospital of Wisconsin/Medical College of WisconsinMilwaukeeUSA
  2. 2.Department of SurgeryUniversity of WashingtonSeattleUSA
  3. 3.Division of Quantitative Health Sciences, Department of PediatricsMedical College of WisconsinMilwaukeeUSA

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