Article: Courtney, Alyssa, et al. "Bolus versus continuous nasogastric feeds for infants with bronchiolitis: a randomized trial." Hospital Pediatrics 12.1 (2022): 1-10. DOI: 10.1542/hpeds.2020-005702
Fellow: Dimple Patel, MD; Kaiser Oakland Medical Center
Summary: This study was done in Australia, where nasogastric (NG) feeding is the standard practice over intravenous hydration in infants hospitalized to the pediatric ward with bronchiolitis. Continuous NG feeds are thought to be anecdotally safer in children with respiratory distress but can potentially prolong hospital admission. The authors conducted a randomized, open, parallel-group, superiority clinical trial of bolus versus continuous NG feeds in infants with bronchiolitis. There was no significant difference in length of stay (LOS) between bolus and continuous NG feedings (median LOS of the bolus group 54.25 hours versus 56 hours in the continuous group). There was also a higher proportion of admissions to the pediatric intensive care unit in the continuous NG feeding group.
Key Strengths: The randomized, parallel-group superiority design is a strength. There was no significant difference in the demographics in the bolus and continuous NG feeding groups after randomization. Also, the authors used the time the patient was “fit for discharge,” since LOS can be affected by many factors not related to the clinical condition.
Limitations/Flaws: This was an open study, where continuous versus bolus regimens was known to the families and medical team (the subjects and researchers are not truly blinded). This study only included infants <12 months of age (per the Australian definition of bronchiolitis), which limits generalizability to infants with bronchiolitis in the 12–24 month category per the United States definition. Also, this study was only powered to detect a LOS difference >24 hours. However, bronchiolitis hospitalizations have a quick turnaround, so having higher power (through a larger sample size) to detect a smaller LOS difference of 6-12 hours may be more revealing.
Takeaway Message: In this study, there was no significant difference in LOS between bolus and continuous NG feedings in the population. There were no clinically significant pulmonary aspiration events. A larger sample size to generate higher power to detect shorter time differences is needed.
Practice Impact: When encountering a hospitalized infant with bronchiolitis, continuous or bolus NG feeds can be initiated. Bolus feeding mimics usual feeding and physiology and can be an appropriate method of feeding in this population. Nasogastric hydration is often forgotten but is an appropriate route for rehydration.
Fellow: Dimple Patel, MD; Kaiser Oakland Medical Center
Summary: This study was done in Australia, where nasogastric (NG) feeding is the standard practice over intravenous hydration in infants hospitalized to the pediatric ward with bronchiolitis. Continuous NG feeds are thought to be anecdotally safer in children with respiratory distress but can potentially prolong hospital admission. The authors conducted a randomized, open, parallel-group, superiority clinical trial of bolus versus continuous NG feeds in infants with bronchiolitis. There was no significant difference in length of stay (LOS) between bolus and continuous NG feedings (median LOS of the bolus group 54.25 hours versus 56 hours in the continuous group). There was also a higher proportion of admissions to the pediatric intensive care unit in the continuous NG feeding group.
Key Strengths: The randomized, parallel-group superiority design is a strength. There was no significant difference in the demographics in the bolus and continuous NG feeding groups after randomization. Also, the authors used the time the patient was “fit for discharge,” since LOS can be affected by many factors not related to the clinical condition.
Limitations/Flaws: This was an open study, where continuous versus bolus regimens was known to the families and medical team (the subjects and researchers are not truly blinded). This study only included infants <12 months of age (per the Australian definition of bronchiolitis), which limits generalizability to infants with bronchiolitis in the 12–24 month category per the United States definition. Also, this study was only powered to detect a LOS difference >24 hours. However, bronchiolitis hospitalizations have a quick turnaround, so having higher power (through a larger sample size) to detect a smaller LOS difference of 6-12 hours may be more revealing.
Takeaway Message: In this study, there was no significant difference in LOS between bolus and continuous NG feedings in the population. There were no clinically significant pulmonary aspiration events. A larger sample size to generate higher power to detect shorter time differences is needed.
Practice Impact: When encountering a hospitalized infant with bronchiolitis, continuous or bolus NG feeds can be initiated. Bolus feeding mimics usual feeding and physiology and can be an appropriate method of feeding in this population. Nasogastric hydration is often forgotten but is an appropriate route for rehydration.