(890) Nutrition Support With Human Milk in Critically Ill Children < 6 Months of Age Admitted to PICU

Introduction: There is extensive evidence showing human milk (HM) is crucial in providing optimal nutrition during illness and decreasing mortality among infants who are malnourished. Yet, there is minimal research on the use of human milk in pediatric intensive care settings. This study aimed to examine the prevalence and identify patient characteristics, evaluate nutrition support adequacy, and outcomes in infants using human milk who are admitted to the pediatric intensive care unit (PICU).

Methods: Retrospective study of infants < 6 months admitted to PICU (index) and fed HM from Jan 2021 to Feb 2024. Nutritional evaluation by WHO growth charts z-scores. Nutrition goals by the dietitian and modality of feeds collected on the first week of admission. Risk of mortality (ROM) by the Pediatric Index of Mortality (PIM3).

Results: From 1,123 patients, 187 infants (16.65%) < 6 months of age were included. Median age: 1.48 months (IQR;0.79-2.55); weight: 4.56 kg (3.76-5.76); gestational age: 38 weeks (37-39), PIMS 3 ROM (%): 0.20 (0.50-3.40); PICU length of stay (LOS): 7.17 days (3.90-12.5); Hospital LOS 12.29 days (7.77-24). Weight-for-age z-score: 0.23±1.20 (SD) for an underweight prevalence of 3.74% and hospital mortality of 2.36%. The majority of diagnoses were medical 95.7% where 78.1% had a respiratory diagnosis with 57.1% requiring mechanical ventilation. For days 1,3,5, and 7, goal feeds at 15%, 61%, 86%, and 89%. The main modality of feeding was via nasal gastric tube by days 3, 5, and 7 was 61%; 70%, and 72%, respectively. Ninety-four percent of children received a lactation consult and 22% of exclusively breastfed infants received formula during admission. The main barrier identified between infant receiving human milk was mother-baby separation.

Conclusions: The study showed a low point prevalence of human milk use in the PICU. Most infants had normal weight for age z-score, low mortality risk, and no co-morbidities. Majority of patients were exclusively fed human milk prior to admission. Barriers were identified between mother and baby which could have contributed to these patients receiving formula during their admission. The majority of patients’ modality of feeding was nasal gastric tube. Over 60% of patients were on goal feeds by admission day 3.