Assessing the bowel function of critically ill children: a pilot study.

Objective: To describe the bowel function of critically ill children.

Design, Setting And Participants: A prospective, observational study, in a regional tertiary intensive care unit, of children under 16 years of age who were admitted for more than 24 hours. We collected demographic data and captured information on bowel function and stool form and on factors that may affect these, such as medicines and nutrition.

Main Outcome Measures: Bowel activity and duration of administration of aperients and narcotics.

Results: Forty-seven patients (28 boys) with a median age of 3.66 years (IQR, 1-7.62 years) were enrolled and monitored for 219 ICU days, 134 (61.2%) of which were ventilation-bed days. There were no bowel motions seen on 123 days (56.2%), and of the days when motions were passed, the predominant stool form was loose or watery (22%). One patient had clinical features of constipation (0.5%). Aperients were used, predominantly docusate, on 38 days (17.4%), and prokinetics on 28 days (12.8%). Narcotics were used on 156 days (71.2%), and narcotic duration was significantly associated with non-defecation days (Spearman ρ= 0.55, n = 33, P < 0.01). Clinically, reduced gut motility (recorded as absent bowel sounds or increased gastric residual volumes) was seen on a total of 31 days (68.9%).

Conclusions: Critically unwell children needing more than 24 hours of intensive care have a state of non-defecation for most of the time, with formed stools being rare. Further observational studies will better define bowel function in critically unwell children.