=12.559，P=0.128）。校准曲线分析和决策曲线分析提示该模型的预测效能和临床应用价值较高。 结论 卧床时间、休克、胃肠减压、使用非甾体类抗炎药物和联合使用肠外营养是危重患儿EN发生FI的独立危险因素；根据这些因素构建的列线图模型有较高的预测效能和临床应用价值。"/>
χ2=12.559, P=0.128). Calibration curve and decision curve analyses suggested that the model has high predictive efficacy and clinical application value. Conclusions Duration of bed rest, shock, gastrointestinal decompression, use of non-steroidal anti-inflammatory drugs, and combined parenteral nutrition are independent risk factors for FI in critically ill children receiving EN. The nomogram model developed based on these factors exhibits high predictive efficacy and clinical application value."/>
危重症患儿肠内营养喂养不耐受危险因素分析及预测模型的构建
Abstract：Objective To explore the risk factors of feeding intolerance (FI) in critically ill children receiving enteral nutrition (EN) and to construct a prediction nomogram model for FI. Methods A retrospective study was conducted to collect data from critically ill children admitted to the Pediatric Intensive Care Unit of Xiangya Hospital, Central South University, between January 2015 and October 2020. The children were randomly divided into a training set (346 cases) and a validation set (147 cases). The training set was further divided into a tolerance group (216 cases) and an intolerance group (130 cases). Multivariate logistic regression analysis was used to screen for risk factors for FI in critically ill children receiving EN. A nomogram was constructed using R language, which was then validated on the validation set. The model's discrimination, calibration, and clinical net benefit were evaluated using receiver operating characteristic curves, calibration curves, and decision curves. Results Duration of bed rest, shock, gastrointestinal decompression, use of non-steroidal anti-inflammatory drugs, and combined parenteral nutrition were identified as independent risk factors for FI in critically ill children receiving EN (P<0.05). Based on these factors, a nomogram prediction model for FI in critically ill children receiving EN was developed. The area under the receiver operating characteristic curve for the training set and validation set was 0.934 (95%CI: 0.906-0.963) and 0.852 (95%CI: 0.787-0.917), respectively, indicating good discrimination of the model. The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good fit (χ2=12.559, P=0.128). Calibration curve and decision curve analyses suggested that the model has high predictive efficacy and clinical application value. Conclusions Duration of bed rest, shock, gastrointestinal decompression, use of non-steroidal anti-inflammatory drugs, and combined parenteral nutrition are independent risk factors for FI in critically ill children receiving EN. The nomogram model developed based on these factors exhibits high predictive efficacy and clinical application value.
ZHOU Xia,GAO Hong-Mei,HUANG Lin et al. Risk factors and development of a prediction model of enteral feeding intolerance in critically ill children[J]. CJCP, 2025, 27(3): 321-327.
Eveleens RD, Joosten KFM, de Koning BAE, et al. Definitions, predictors and outcomes of feeding intolerance in critically ill children: a systematic review[J]. Clin Nutr, 2020, 39(3): 685-693. PMID: 30962102. DOI: 10.1016/j.clnu.2019.03.026.
Lee ZY, Ibrahim NA, Mohd-Yusof BN. Prevalence and duration of reasons for enteral nutrition feeding interruption in a tertiary intensive care unit[J]. Nutrition, 2018, 53: 26-33. PMID: 29627715. DOI: 10.1016/j.nut.2017.11.014.
Leong AY, Cartwright KR, Guerra GG, et al. A Canadian survey of perceived barriers to initiation and continuation of enteral feeding in PICUs[J]. Pediatr Crit Care Med, 2014, 15(2): e49-e55. PMID: 24196008. DOI: 10.1097/PCC.0000000000000016.
Tume LN, Arch B, Woolfall K, et al. Determining optimal outcome measures in a trial investigating no routine gastric residual volume measurement in critically ill children[J]. JPEN J Parenter Enteral Nutr, 2021, 45(1): 79-86. PMID: 32144809. DOI: 10.1002/jpen.1817.
Manning JC, Pinto NP, Rennick JE, et al. Conceptualizing post intensive care syndrome in children: the PICS-p framework[J]. Pediatr Crit Care Med, 2018, 19(4): 298-300. PMID: 29406379. DOI: 10.1097/PCC.0000000000001476.
Chusilp S, Yamoto M, Vejchapipat P, et al. Nasogastric decompression after intestinal surgery in children: a systematic review and meta-analysis[J]. Pediatr Surg Int, 2021, 37(3): 377-388. PMID: 33564932. DOI: 10.1007/s00383-020-04818-6.
Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically Ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition[J]. Pediatr Crit Care Med, 2017, 18(7): 675-715. PMID: 28691958. DOI: 10.1097/PCC.0000000000001134.
