Nutritional deficits in paediatric extracorporeal membrane oxygenation patients: the impact of lipid-free parenteral nutrition on caloric intake and outcomes.

Background and aim: When extracorporeal membrane oxygenation (ECMO) was first introduced for paediatric patients, lipid emulsions were mostly administered directly into the ECMO circuit. However, clinicians have observed that lipid emulsions tend to separate and agglutinate within the circuit, raising concerns about potential complications. Many institutions therefore opted to exclude lipids from parenteral regimens, inadvertently leading to inadequate nutritional support for these critically ill patients. This study measured the caloric deficit resulting from the lack of lipid provision to paediatric ECMO patients in relation to the patients' basal energy expenditure (BEE) and explored the resulting nutritional outcomes. Methods and results: This was a retrospective, single-centre study conducted at a tertiary care hospital. All paediatric ECMO patients receiving parenteral nutrition (PN) from the period of April 2020 to April 2023 were included in the study.Twenty-three patients were identified. Of these, 18 (78.26%) did not achieve the target BEE. The average calorie deficit of all patients was 40.23% of the calculated BEE (SD=17.468%). Of the patients who had a calorie deficit, eight (50%) died. No significant differences were found in patients' weights before and after stopping PN (p=0.3594). Conclusion: This study explored the challenge of meeting the nutritional needs of paediatric ECMO patients when lipids are excluded from PN. Significant caloric deficits require alternative strategies to prevent patient malnourishment without affecting the ECMO circuit's functionality.