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  • Clinical Research Article
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Enteral feeding in pediatric patients with bronchiolitis requiring non-invasive support via nasal interface

Pediatric Research volume 98, pages 1892–1896 (2025)Cite this article

Abstract

Background and objectives

The benefits of enteral feeding in critically ill children have been well described, but the use of non-invasive respiratory support has been shown to delay initiation of feeds, in part due to safety concerns. We aimed to examine the association of enteral feeding by mouth and orogastric tube on clinically significant adverse events in children with bronchiolitis being treated with non-invasive respiratory support via nasal interfaces.

Methods

A retrospective cohort study of patients 0–24 months of age between 2016 and 2022 in a quaternary care hospital pediatric intensive care unit with a diagnosis of bronchiolitis and treatment with non-invasive respiratory support via nasal interface. Standard comparative statistics and multivariable regression were used to determine the association between oral and nasogastric feeding and clinically significant outcomes such as new diagnosis of pneumonia and escalation in respiratory support, as well lengths of stay.

Results

There were 407 patients 24 months or younger who were admitted with bronchiolitis and treated with non-invasive respiratory support. There was a 4.65 increased odds of developing a new pneumonia for patients who were fed nasogastrically versus orally. There were no differences in the development of pneumonia based on type of respiratory support, whether an escalation in respiratory support was needed, or based on the highest level of support received. Both pediatric intensive care unit and overall hospital lengths of stay were decreased in those who were orally fed.

Conclusions

Enteral feeding in children with bronchiolitis receiving non-invasive respiratory support appears to be safe and not associated with escalation in support or new diagnoses of pneumonia. Oral feeds were associated with decreased lengths of stay. Further work is needed to assess long term safety and ability to achieve adequate nutritional requirements.

Impact

  • Enteral feeding of children with bronchiolitis requiring non-invasive respiratory support via nasal interfaces did not have an effect on clinically significant adverse events

  • Feeding by mouth led to decreased risk of pneumonia and shorter inpatient length of stay

  • Future work is needed to study the ability to achieve nutrition goals when feeding by mouth on non-invasive support

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Division of Pediatric Critical Care Medicine, MassGeneral Brigham for Children, Boston, MA, USA

    Kelsey Finnegan, Julia Smalley, Barbara Gallagher, Michael Salt, Kimberly Whalen & Michael R. Flaherty

  2. Harvard Medical School, Boston, MA, USA

    Michael Salt & Michael R. Flaherty

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  1. Kelsey Finnegan
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  2. Julia Smalley
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  3. Barbara Gallagher
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  4. Michael Salt
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  5. Kimberly Whalen
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  6. Michael R. Flaherty
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Contributions

Kelsey Finnegan: conceptualized and designed the study, coordinated data collection and acquisition of data, interpreted data, drafted the initial manuscript, and approved the final manuscript as submitted. Julia Smalley: conceptualized and designed the study, coordinated data collection and acquisition of data, drafted the initial manuscript, and approved the final manuscript as submitted. Barbara Gallagher: conceptualized and designed the study, coordinated data collection and acquisition of data, drafted the initial manuscript, and approved the final manuscript as submitted. Michael Salt: analyzed and interpreted the data, reviewed and revised the manuscript, and approved the final manuscript as submitted. Kimberly Whalen: coordinated data collection and acquisition of data, drafted the initial manuscript, and approved the final manuscript as submitted. Michael Flaherty: conceptualized and designed the study, analyzed and interpreted data, drafted the initial manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Michael R. Flaherty.

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Finnegan, K., Smalley, J., Gallagher, B. et al. Enteral feeding in pediatric patients with bronchiolitis requiring non-invasive support via nasal interface. Pediatr Res 98, 1892–1896 (2025). https://doi.org/10.1038/s41390-025-04022-z

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