Oral Nutrition in Children With Bronchiolitis on High-Flow Nasal Cannula Is Well Tolerated

Objectives: To determine the incidence of aspiration-related respiratory failure and nutrition interruptions in children with bronchiolitis on high-flow nasal cannula (HFNC) receiving enteral nutrition.

Methods: We performed a single-center, prospective, observational cohort study within a 313-bed tertiary medical center from January through December 2015. We included term children 1 month to 2 years of age without comorbid bacterial pneumonia or chronic medical conditions who were diagnosed with bronchiolitis while receiving HFNC and enteral nutrition. Primary outcomes were incidence of aspiration-related respiratory failure and nutrition interruptions. Secondary outcomes were duration of HFNC therapy, length of stay, and nutrition characteristics.

Results: Of the 344 children admitted with bronchiolitis, 132 met the inclusion criteria. Ninety-seven percent received enteral nutrition by mouth and 3% by nasogastric tube. HFNC flow rates at the time of nutrition initiation ranged between 4 and 13 L per minute (0.3-1.9 L/kg per minute) and respiratory rates from 18 to 69 breaths per minute. One (0.8%) subject had aspiration-related respiratory failure and 12 (9.1%) experienced nutrition interruptions. Children with interruptions in nutrition had a longer length of stay by 2.5 days ( < .01) and received an additional day of HFNC therapy ( < .01). By discharge, 55 (42%) children achieved all nutritional goals: caloric, volume, and protein. Children admitted overnight had an increased incidence of delay to nutrition initiation (30% vs 11%; < .01).

Conclusions: We observed a low incidence of aspiration-related respiratory failure in term children with bronchiolitis on HFNC receiving enteral nutrition. Oral nutrition was tolerated across a range of HFNC flow and respiratory rates, suggesting the practice of withholding nutrition in this population is unsupported.