ENTERAL FEEDING INTOLERANCE - AN INDICATOR OF SEPSIS-ASSOCIATED MORTALITY IN BURNED CHILDREN

Objective: To determine if enteral feeding intolerance (EFI) is associ ated with sepsis and increased mortality in children with severe burns . Design: A survey. Setting: A pediatric burn unit. Patients: Ninety-o ne children surviving longer than 5 days with greater than 80% total b ody surface area burns. Interventions: None. Main Outcome Measures: En teral feeding intolerance indicated by high gastric residuals (>150 mL /h) or uncontrollable diarrhea (>2500 mL/d); thrombocytopenia (platele t count <100 X 10(9)/L); hyperglycemia (glucose level >11.1 mmol/L [>2 00 mg/dL]); sepsis (pathogenic bacteremia or fungemia noted on blood c ulture results); and mortality. Results: Neither EFI nor sepsis develo ped in 71 patients, EFI alone developed in 2 patients, sepsis alone de veloped in 5 patients, and EFI and sepsis developed in 13 patients. En teral feeding intolerance and sepsis were associated by contingency ta ble analysis (P<.001). Mortality was 8% (6 patients) in these with nei ther EFI nor sepsis, 50% (1 patient) in those with EFI alone, 60% (3 p atients) in those with sepsis alone, and 77% (10 patients) in those wi th 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 hyp erthermia, no variables were found to be superior to others for predic ting sepsis. Conclusions: Enteral feeding intolerance was associated w ith the development of sepsis and increased mortality in children with greater than 80% total body surface area burns. This sign was identif ied in 70% of the cases before pathogens were found in the blood; no d ifference could be shown between the identification of EFI, thrombocyt openia, and hyperglycemia before sepsis. These data indicate that the development of EFI should be used as an indicator of infection and sho uld prompt a search for an inciting focus.