Nutrition in neonatal and pediatric patients on extracorporeal membrane oxygenation: A survey of current practice in the US and Canada
Bibliographic record
Abstract
Abstract Background: Patients requiring extracorporeal membrane oxygenation (ECMO) are at increased risk of malnutrition due to high rates of protein catabolism, unclear metabolic needs, and safety risks with both parenteral and enteral nutrition (EN). Malnourishment is associated with increased morbidity and mortality, and improved EN and protein intake are associated with decreased 60-day mortality. A standardized practice for nutrition therapy in this population is unestablished. We aim to provide an update on current nutritional practices in pediatric and neonatal patients receiving ECMO support. Subjects and Methods: An online survey was distributed to ECMO medical directors in the US and Canada who had previously participated in survey-based research and those who requested participation during a pediatric ECMO presentation of this study. Each medical director was asked to forward the survey to their center’s registered dietitians (RDs). Results: Of 100 institutions surveyed, 36 physicians and 19 RDs responded yielding a physician response rate of 36% and an RD response rate of 19%. Physicians report “always” providing nutrition parenterally 28% and enterally 17% of the time with 11% of institutions using a protocolized approach. Nutrition therapy aids reduction of morbidity and mortality; however, there is variability in its delivery. Conclusions: Compared to 2015, EN is reported to be less utilized (47% vs. 55%) with less protocol use (11% vs. 38%). These data support the need for the development of a stepwise nutritional support algorithm, which is congruent with the recommendations in the Extracorporeal Life Support Organization Nutrition Guidelines.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".