{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:25:59Z","timestamp":1784042759905,"version":"3.55.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether vasoactive-inotropic drug use impedes the early initiation of enteral nutrition (EN) and affects energy intake adequacy in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective observational cohort study was conducted among pediatric ECMO patients between June 2018 and June 2024. Patients were categorized into early (\u2264 48 h) and delayed (&amp;gt; 48 h) EN initiation groups, and into energy-deficient (&amp;lt; 30% of energy target) and non-deficient (\u2265 30%) groups based on daily EN energy intake during the first five ECMO days. Vasoactive-Inotropic Score (VIS), PRISM III score, EN interruptions, and energy intake adequacy were analyzed. Spearman correlation and Cohen\u2019s d were used to explore associations between VIS and EN intake. A support vector machine (SVM) model was used to identify predictors of energy intake status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 64 patients were included, with 43 (67.2%) receiving EN within 48 h. VIS did not significantly differ between early and delayed EN groups. Delayed EN was associated with higher PRISM III scores (<jats:italic>P<\/jats:italic> = 0.037), lower EN energy intake (<jats:italic>P<\/jats:italic> &amp;lt; 0.001), and more frequent EN interruptions (<jats:italic>P<\/jats:italic> = 0.028). Among patients with EN intake &amp;lt;30% of the target, VIS was significantly higher (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). VIS on days 1 and 2 were the top predictors in the SVM model (25.7% and 27.4%, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Vasoactive-inotropic drug use does not impede the early initiation of EN in pediatric ECMO patients. However, higher VIS in the initial 48 h is associated with suboptimal energy delivery. These findings suggest that while EN can be started early despite vasoactive support, closer monitoring of hemodynamic status is warranted to optimize nutritional adequacy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1676280","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:23:40Z","timestamp":1760365420000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical practice insight: vasoactive-inotropic drugs do not impede early enteral nutrition in pediatric ECMO support"],"prefix":"10.3389","volume":"12","author":[{"given":"Ye","family":"Ren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Run","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxing","family":"Dang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueqiang","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengjun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1097\/CCM.0000000000001713","article-title":"Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically Ill children in the PICU.","volume":"44","author":"Bechard","year":"2016","journal-title":"Crit Care Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.nut.2016.05.002","article-title":"Nutritional status as a predictor of duration of mechanical ventilation in critically ill children.","volume":"33","author":"Grippa","year":"2017","journal-title":"Nutrition."},{"key":"B3","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1053\/j.semperi.2013.11.002","article-title":"Update and outcomes in extracorporeal life support.","volume":"38","author":"Paden","year":"2014","journal-title":"Semin Perinatol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s12519-018-0175-1","article-title":"Chinese guidelines for the assessment and provision of nutrition support therapy in critically ill children.","volume":"14","author":"Zhu","year":"2018","journal-title":"World J Pediatr."},{"key":"B5","doi-asserted-by":"publisher","first-page":"831930","DOI":"10.3389\/fimmu.2022.831930","article-title":"Inflammation and oxidative stress in the context of extracorporeal cardiac and pulmonary support.","volume":"13","author":"Hatami","year":"2022","journal-title":"Front Immunol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1002\/jpen.1032","article-title":"Impact of early initiation of enteral nutrition on survival during pediatric extracorporeal membrane oxygenation.","volume":"42","author":"Greathouse","year":"2018","journal-title":"JPEN J Parenter Enteral Nutr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s00134-024-07338-2","article-title":"Use of vasopressors and inotropes in ECMO.","volume":"50","author":"Levy","year":"2024","journal-title":"Intensive Care Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1053\/j.sempedsurg.2019.01.008","article-title":"Controversies of enteral nutrition in select critically-ill surgical patients: traumatic brain injury, extracorporeal life support, and sepsis.","volume":"28","author":"Rice-Townsend","year":"2019","journal-title":"Semin Pediatr Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1097\/MAT.0000000000001767","article-title":"Extracorporeal life support organization guidelines for the provision and assessment of nutritional support in the neonatal and pediatric ECMO patient.","volume":"68","author":"Lee","year":"2022","journal-title":"ASAIO J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1177\/0148607110369225","article-title":"A.S.P.E.N. 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