None listed
Conditions
Brief summary
Viral bronchiolitis is the most common cause of hospital admission in infants. Annually at the Queensland Children's Hospital approximately 500 infants are admitted overnight. It is common for infants with moderate to severe respiratory distress to be commenced on continuous nasogastric feeds. This is based on an anecdotal hypothesis that it will reduce the risk of pulmonary aspiration and decrease splinting of the diaphragm which reduces respiratory effort. No published evidence could be found to support this. The process of upgrading from continuous to bolus to oral feeds can take 24-72 hours, likely prolonging admission and contributing to the burden of bronchiolitis on families and the health system. The aim of this study is to establish whether continuous nasogastric feeding prolongs hospital length of stay in infants admitted with a clinical diagnosis of bronchiolitis. The inter-departmental study also aims to establish that bolus nasogastric feeding in bronchiolitis is not associated with the adverse outcome of aspiration or paediatric intensive care admission.
Interventions
Infants less than 12 months who are admitted with bronchiolitis and require supplemental nasogastric fluids will be randomised to bolus nasogastric feeding compared to continuous nasogastric feeds. Both are currently clinically acceptable interventions.
Group A will be commenced on bolus 2-3 hourly nasogastric feeds at a rate and volume according to the patient's weight as outlined in the Children's Health Queensland (CHQ) Guideline and the Australasian PREDICT Bronchiolitis Guideline. Patients
Infants less than 12 months who are admitted with bronchiolitis and require supplemental nasogastric fluids will be randomised to bolus nasogastric feeding compared to continuous nasogastric feeds. Both are currently clinically acceptable interventions. Group A will be commenced on bolus 2-3 hourly nasogastric feeds at a rate and volume according to the patient's weight as outlined in the Children's Health Queensland (CHQ) Guideline and the Australasian PREDICT Bronchiolitis Guideline. Patients will be stratified into two groups based on age. These groups will be 0-5 months and 6-12 months of age. Their treating team can progress to oral feeding when deemed clinically appropriate. Patients severely unwell and admitted directly to the paediatric intensive care unit (PICU) will be stratified separately. Consent is gained by the General Paediatric treating team upon clinical requirement of nasogastric supplementation. The treating team, nursing staff, and research team oversaw adherence to the intervention unless a paediatrician or paediatric intensivist deemed it clinically necessary to convert to continuous feeds or intravenous therapy. The patient's nasogastric tube was labelled with the allocated intervention.
Sponsors
Dr Alyssa Courtney
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
No minimum to 12 Months
Healthy volunteers
No
Inclusion criteria
Inclusion Criteria • Infants less than 12 months corrected age • Clinical diagnosis of bronchiolitis • Requiring nasogastric feeding • Parents / guardian read and understand English
Exclusion criteria
Exclusion Criteria • Neurological disease with impairment of tone/swallowing/feeding • Already receiving nasogastric or gastrostomy feeding prior to admission • Any contraindication to insertion of nasogastric tube e.g. choanal atresia • Inability to insert nasogastric tube
Outcome results
None listed