LAUSR

Learning Objectives: We have previously shown that delayed gastric emptying is prevalent and correlates with successful enteral nutrition (EN) advancement in critically ill children. Gastrointestinal (GI) hormones orchestrate gastric emptying in health. A potential mechanism for delayed gastric emptying and limited EN advancement in pediatric critical illness is an alteration in GI hormones. We aimed to describe GI hormone profiles during pediatric critical illness and their relationship with successful EN advancement. Methods: We determined GI hormone levels and EN delivery in a diverse cohort of critically ill children. Total amylin, active ghrelin, total glucagon like peptide-1 (GLP-1), total gastric inhibitory polypeptide (GIP), glucagon, total peptide-PYY (PYY) and cholecystokinin (CCK) were measured using ELISA techniques and a multiplex hormone panel. Correlation and regression analyses were performed between EN advancement, specifically time to 50% EN goal, and GI hormone levels. Principal Component Analysis (PCA) was used to decrease the dimensionality of the data. Results: Fourteen patients with complete data were included, median age was 9.8 years (6.2, 14.9), 57.1% were male, 12 (85.7%) patients had primary respiratory illness and 13 (92.8%) required mechanical ventilation. We identified a positive correlation between EN advancement and serum levels of amylin (r=0.0521, p=0.046), glucagon (r=0.639, p=0.010) and glucose (r=0.777, p< 0.0001) on univariate analysis. In PCA, three components (PCs) representing composite GI hormone profiles accounted for 75% of the variance and thus were further analyzed to determine the relationship between these composite hormone profiles and EN advancement. Hormone profiles PC2 (GLP-1, amylin and glucagon) and PC3 (GIP and ghrelin) were significantly related to EN advancement (r=0.795, p=0.011). The relationship between EN advancement and values of GLP-1, amylin, and glucagon was positive, and negative between EN advancement and values of GIP and ghrelin. Conclusions: Measurement of GI hormone levels in pediatric critical illness is feasible and informative. GI hormone profiles have a complex and independent relationship with EN advancement. Thus, metabolic hormone profiling may allow for the development of diagnostic models for successful EN advancement and may guide future therapeutic alternatives.