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Background: Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings., Objective: To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improve nutrition delivery in critically ill children receiving mechanical ventilation., Methods: Five hundred seventy-nine abstracts met the inclusion criteria and were screened by 2 reviewers according to prespecified criteria. Full-text reviews were performed on 28 articles; 11 studies were selected for detailed analysis. Because of the small number of eligible studies, broader searches were conducted., Results: Only 5 studies with a collective enrollment of fewer than 200 children closely addressed the specific research question. These 5 studies did not report any similarity in feeding regimens, nor did they report nutritional outcomes. Two of the articles described findings from the same study population. Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis., Conclusions: The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation., (©2020 American Association of Critical-Care Nurses.)

Background: The preferred route for providing nutrition in the pediatric intensive care unit is enteral. Placement of postpyloric feeding tubes using an electromagnetic-tipped stylet that emits a signal detected by a device held over the patient's abdomen is effective in adult intensive care units, but has not been well studied in pediatric units., Objectives: To determine the effectiveness of the electromagnetic device in reducing the numbers of radiation exposures, intrahospital transports, tubes used, and tube placement attempts in the pediatric intensive care unit., Methods: Data from a historical control group were compared with data from a prospective intervention group of patients less than 18 years of age and weighing at least 3 kg who required a postpyloric feeding tube in a 23-bed pediatric intensive care unit. Primary outcome was number of radiation exposures. Independent-samples Student t tests were used to compare the 2 study groups for mean equality; Pearson χ 2 tests were used to compare categorical data. Statistical testing was 2-sided, and P less than .05 was considered statistically significant., Results: Of 73 children (30 in control group, 43 in intervention group), those in the intervention group had a higher success rate at tube placement ( P = .009) and fewer radiation exposures ( P = .006), intrahospital transports ( P = .004), and tubes used ( P < .001)., Conclusions: Successful placement of postpyloric feeding tubes by nurse practitioners was safely enhanced using an electromagnetic device. Establishing users' expertise with the device before studying outcomes may improve effectiveness., (©2017 American Association of Critical-Care Nurses.)