1
|
Afroze F, Khoshnevisan F, Harawa PP, Islam Z, Bourdon C, Khoswe S, Islam M, Sarker SA, Islam F, Sayeem Bin Shahid ASM, Joosten K, Hulst JM, Eneya C, Walson JL, Berkley JA, Potani I, Voskuijl W, Ahmed T, Chisti MJ, Bandsma RHJ. Trajectories of resting energy expenditure and performance of predictive equations in children hospitalized with an acute illness and malnutrition: a longitudinal study. Sci Rep 2024; 14:3613. [PMID: 38351162 PMCID: PMC10864294 DOI: 10.1038/s41598-024-53791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
There is scarce data on energy expenditure in ill children with different degrees of malnutrition. This study aimed to determine resting energy expenditure (REE) trajectories in hospitalized malnourished children during and after hospitalization. We followed a cohort of children in Bangladesh and Malawi (2-23 months) with: no wasting (NW); moderate wasting (MW), severe wasting (SW), or edematous malnutrition (EM). REE was measured by indirect calorimetry at admission, discharge, 14-and-45-days post-discharge. 125 children (NW, n = 23; MW, n = 29; SW, n = 51; EM, n = 22), median age 9 (IQR 6, 14) months, provided 401 REE measurements. At admission, the REE of children with NW and MW was 67 (95% CI [58, 75]) and 70 (95% CI [63, 76]) kcal/kg/day, respectively, while REE in children with SW was higher, 79 kcal/kg/day (95% CI [74, 84], p = 0.018), than NW. REE in these groups was stable over time. In children with EM, REE increased from admission to discharge (65 kcal/kg/day, 95% CI [56, 73]) to 79 (95% CI [72, 86], p = 0.0014) and was stable hereafter. Predictive equations underestimated REE in 92% of participants at all time points. Recommended feeding targets during the acute phase of illness in severely malnourished children exceeded REE. Acutely ill malnourished children are at risk of being overfed when implementing current international guidelines.
Collapse
Affiliation(s)
- Farzana Afroze
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farnaz Khoshnevisan
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Translational Medicine, Hospital for Sick Children, Toronto, Canada
| | - Philliness Prisca Harawa
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Zahidul Islam
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Celine Bourdon
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Translational Medicine, Hospital for Sick Children, Toronto, Canada
| | - Stanley Khoswe
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Munirul Islam
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shafiqul Alam Sarker
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Islam
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Sadat Mohammad Sayeem Bin Shahid
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Koen Joosten
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jessie M Hulst
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Chisomo Eneya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Judd L Walson
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - James A Berkley
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Isabel Potani
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Wieger Voskuijl
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Paediatrics, Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tahmeed Ahmed
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nutrition Research Division (NRD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Robert H J Bandsma
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya.
- Translational Medicine, Hospital for Sick Children, Toronto, Canada.
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi.
| |
Collapse
|
2
|
Joosten K, Verbruggen S. PN Administration in Critically Ill Children in Different Phases of the Stress Response. Nutrients 2022; 14:nu14091819. [PMID: 35565787 PMCID: PMC9104104 DOI: 10.3390/nu14091819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 01/22/2023] Open
Abstract
Nutritional support is an important part of the treatment of critical ill children and the phase of disease has to be taken into account. The metabolic stress response during acute critical illness is characterized by severe catabolism. So far, there is no evidence that the acute catabolic state can be prevented with nutritional support. The Pediatric ’Early versus Late Parenteral Nutrition’ (PEPaNIC) trial showed that withholding supplemental parenteral nutrition (PN) during the first week in critically ill children, when enteral nutrition was not sufficient, prevented infections and shortened the stay in the pediatric intensive care unit (PICU) and the hospital. A follow-up performed 2 and 4 years later showed that withholding parenteral nutrition (PN) also improved several domains of the neurocognitive outcome of the children. Current international guidelines recommend considering withholding parenteral macronutrients during the first week of pediatric critical illness, while providing micronutrients. These guidelines also recommend upper and lower levels of intake of macronutrients and micronutrients if PN is administered.
Collapse
|
3
|
Tume LN, Valla FV, Joosten K, Jotterand Chaparro C, Latten L, Marino LV, Macleod I, Moullet C, Pathan N, Rooze S, van Rosmalen J, Verbruggen SCAT. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med 2020; 46:411-425. [PMID: 32077997 PMCID: PMC7067708 DOI: 10.1007/s00134-019-05922-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/28/2019] [Indexed: 01/09/2023]
Abstract
Background Nutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines. Objective To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children. Design The metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds. Results The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions. Conclusions We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions. Electronic supplementary material The online version of this article (10.1007/s00134-019-05922-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lyvonne N Tume
- Faculty of Health and Society, University of Salford, Manchester, M6 6PU, UK. .,Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, East Prescot Road, Liverpool, L12 2AP, UK.
| | - Frederic V Valla
- Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, CarMEN INSERM UMR, 1060 Hospices Civils de Lyon, Lyon-Bron, France
| | - Koen Joosten
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Corinne Jotterand Chaparro
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland.,Pediatric Intensive Care Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Lynne Latten
- Nutrition and Dietetics, Alder Hey Children's Hospital Liverpool, Liverpool, UK
| | - Luise V Marino
- Department of Dietetics/Speech and Language Therapy, NIHR Biomedical Research Centre Southampton, University Hospital Southampton, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Isobel Macleod
- Pediatric Intensive Care Unit, Royal Hospital for Children, Glasgow, UK
| | - Clémence Moullet
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland.,Pediatric Intensive Care Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nazima Pathan
- Department of Pediatrics, University of Cambridge, Hills Road, Cambridge, UK
| | - Shancy Rooze
- Pediatric Intensive Care Unit, Queen Fabiola Children's University Hospital, Brussels, Belgium
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sascha C A T Verbruggen
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Fernández R, Urbano J, Carrillo Á, Vivanco A, Solana MJ, Rey C, López-Herce J. Comparison of the effect of three different protein content enteral diets on serum levels of proteins, nitrogen balance, and energy expenditure in critically ill infants: study protocol for a randomized controlled trial. Trials 2019; 20:585. [PMID: 31604481 PMCID: PMC6787979 DOI: 10.1186/s13063-019-3686-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Nutritional support is essential in the care of critically ill children since malnutrition in this population is associated with increased morbidity and mortality. Injury in patients admitted to pediatric intensive care units (PICU) results in a catabolic state and augmented protein breakdown, leading to a negative protein balance. Current recommendations about protein prescription in the PICU are fundamentally based on expert opinions, and the minimum threshold is 1.5 g/kg per day of protein, although protein needs could be higher in certain subgroups of patients. The main objectives of the present study are to examine whether the administration of a protein-enriched infant formula increases the serum levels of total proteins, albumin, prealbumin, transferrin, and retinol and improves nitrogen balance and to analyze the effect of the high-protein diet on energy expenditure. A secondary objective is to register possible secondary effects of the protein-enriched diet. Methods A multicenter prospective randomized controlled trial (RCT) will be performed in three hospitals. Patients meeting inclusion criteria will be randomly allocated to one of three enteral feeding formulae with different protein contents. Blood and urine test, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry will be performed at the beginning of the nutrition regimen and at 24 h, 72 h and 5–7 days after initiation. The sample size for this trial is estimated to be 90 participants (about 30 participants in each group). The data analysis will be by intention to treat. Discussion This RCT will provide new data about the amount of protein needed to improve levels of serum protein and nitrogen balance, a surrogate of protein balance, in critically ill infants receiving enteral nutrition. Trial registration ClinicalTrials.gov identifier: NCT03901742. Registered April 1, 2019 – Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13063-019-3686-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Reyes Fernández
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Urbano
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain. .,Maternal and Child Health and Development Research Network (REDSAMID), Institute of Health Carlos III, Madrid, Spain. .,Universidad Complutense de Madrid, Madrid, Spain.
| | - Ángel Carrillo
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain.,Maternal and Child Health and Development Research Network (REDSAMID), Institute of Health Carlos III, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Vivanco
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María José Solana
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain.,Maternal and Child Health and Development Research Network (REDSAMID), Institute of Health Carlos III, Madrid, Spain
| | - Corsino Rey
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain.,Maternal and Child Health and Development Research Network (REDSAMID), Institute of Health Carlos III, Madrid, Spain.,Universidad de Oviedo, Oviedo, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain.,Maternal and Child Health and Development Research Network (REDSAMID), Institute of Health Carlos III, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
5
|
Ventura JC, Hauschild DB, Barbosa E, Bresolin NL, Kawai K, Mehta NM, Moreno YMF. Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children. J Acad Nutr Diet 2019; 120:219-229. [PMID: 31522971 DOI: 10.1016/j.jand.2019.06.250] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/23/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND There are few studies that assess the role of different nutritional assessment variables at pediatric intensive care unit (PICU) admission in predicting clinical outcomes. OBJECTIVE To identify nutritional variables in the first 4 days of PICU stay that predict 60-day mortality and time to discharge alive from the PICU. DESIGN Single-center prospective study in Southern Brazil, conducted between July 2013 and February 2016. At PICU admission, children with z scores <-2 for body mass index (BMI)-for-age, mid-upper arm circumference (MUAC)-for-age, and triceps skinfold thickness (TSF)-for-age were considered as undernourished. PARTICIPANTS/SETTING There were 199 patients, aged <15 years, with PICU stay >48 hours. MAIN OUTCOME MEASURES Sixty-day mortality and time to discharge alive from the PICU. STATISTICAL ANALYSIS PERFORMED Cox regression model was applied to determine predictors of 60-day mortality and time to discharge alive from the PICU. RESULTS Median age was 23.1 months (interquartile range=3.9 to 89.1), and 63% were male, with 18% prevalence of undernutrition at admission by BMI-for-age. Median PICU stay was 7 days (interquartile range=4 to 12), and 60-day mortality was 12%. After adjusting for sex, age, Pediatric Index of Mortality 2, and presence of complex chronic conditions, undernutrition based on BMI-for-age (hazard ratio [HR]=3.75; 95% CI=1.41 to 9.95; P=0.008), MUAC-for-age (HR=7.62; 95% CI=2.42 to 23.97; P=0.001), and TSF-for-age (HR=4.01; 95% CI=1.14 to 14.15; P=0.031) was associated with higher risk of 60-day mortality. Based on MUAC-for-age with the same adjustment model, undernourished children had longer time to discharge alive from the PICU (HR=0.45; 95% CI=0.21 to 0.98; P=0.045). CONCLUSIONS Undernutrition at PICU admission based on different anthropometric variables was predictive of 60-day mortality and longer time to discharge alive from the PICU.
Collapse
|
6
|
Marino LV, Eveleens RD, Morton K, Verbruggen SCAT, Joosten KFM. Peptide nutrient-energy dense enteral feeding in critically ill infants: an observational study. J Hum Nutr Diet 2019; 32:400-408. [PMID: 30848864 DOI: 10.1111/jhn.12645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient-energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs). METHODS Records from critically ill infants aged <12 months admitted to two PICUs were retrospectively reviewed with a PICU length of stay (LOS) ≥ 7 days. Achievement of nutritional targets for the duration of PEF was reviewed. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. RESULTS In total, 53 infants were included, with a median age on admission of 2.6 months. Median admission weight was 3.9 kg in PICU-1 and 4.7 kg in PICU-2. Median (interquatile range) energy intake in PICU-1 and PICU-2 was 68 (47-92) and 90 (63-124) kcal kg-1 , respectively, and median (interquatile range) protein intake 1.7 (1.1-2.4) g kg-1 and 2.5 (1.6-3.2) g kg-1 , respectively. Feeding was withheld because of feeding intolerance in one infant (4%) on two occasions in PICU-1 for 2.5 h and in two infants (7%) on two occasions in PICU-2 for 19.5 h. Gastric residual mean (SD) volumes were 3.5 (5.4) mL kg-1 in PICU-1 and 16.9 (15.6) mL kg-1 in PICU-2. CONCLUSIONS Peptide nutrient-energy dense feeding in infants admitted to the PICU is feasible, well tolerated and nutritional targets are met. However, with this study design, it is not possible to draw any conclusions regarding the benefit of PEF over standard PE feed in critically ill children and future work is required to clarify this further.
Collapse
Affiliation(s)
- L V Marino
- Department of Dietetics and Speech & Language Therapy, University of Southampton, Southampton, UK.,NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R D Eveleens
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K Morton
- Faculty of Health Sciences, University of Southampton, Southampton, UK.,Paediatric Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S C A T Verbruggen
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K F M Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Joosten KFM, Eveleens RD, Verbruggen SCAT. Nutritional support in the recovery phase of critically ill children. Curr Opin Clin Nutr Metab Care 2019; 22:152-158. [PMID: 30585805 DOI: 10.1097/mco.0000000000000549] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The metabolic stress response of a critically ill child evolves over time and thus it seems reasonable that nutritional requirements change during their course of illness as well. This review proposes strategies and considerations for nutritional support during the recovery phase to gain optimal (catch-up) growth with preservation of lean body mass. RECENT FINDINGS Critical illness impairs nutritional status, muscle mass and function, and neurocognition, but early and high intakes of artificial nutrition during the acute phase cannot resolve this. Although (parenteral) nutrient restriction during the acute phase appears to be beneficial, persistent nutrient restriction, when the metabolic stress response resolves, has short-term and long-term detrimental consequences. Requirements increase markedly during the recovery phase to enable recovery and catch-up growth. Such large amounts of intake demand for alternate approach, especially when intestinal problems constitute a barrier for full enteral feeding. As part of the nutritional recovery, mobilization and exercise are essential to achieve catch-up growth with an optimal body composition. SUMMARY During the recovery phase of paediatric critical illness (catch-up) growth and muscle recovery require nutritional intakes at least two times the resting energy expenditure.
Collapse
Affiliation(s)
- Koen F M Joosten
- Paediatric Intensive Care, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | | |
Collapse
|
8
|
Tume LN, Valla FV, Floh AA, Goday P, Jotterand Chaparro C, Larsen B, Lee JH, Moreno YMF, Pathan N, Verbruggen S, Mehta NM. Priorities for Nutrition Research in Pediatric Critical Care. JPEN J Parenter Enteral Nutr 2018; 43:853-862. [DOI: 10.1002/jpen.1498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/03/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Lyvonne N. Tume
- Faculty of Health & Applied SciencesUniversity of the West of England Bristol UK
| | - Frédéric V. Valla
- Pediatric Intensive Care UnitHôpital Femme Mère EnfantHospices Civils de Lyon Lyon‐Bron France
| | - Alejandro A. Floh
- Department of PediatricsUniversity of Toronto Toronto Canada
- Cardiac Critical Care UnitDepartment of Critical CareThe Hospital for Sick Children Toronto Canada
| | - Praveen Goday
- Pediatric GastroenterologyNutrition Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Corinne Jotterand Chaparro
- Department of Nutrition and DieteticsUniversity of Applied Sciences Western Switzerland (HES‐SO) Geneva Switzerland
- Pediatric Intensive Care UnitMedico‐Surgical Department of PediatricsUniversity Hospital of Lausanne Lausanne Switzerland
| | - Bodil Larsen
- Department of ALES (Human Nutrition)University of Alberta Edmonton Canada
| | - Jan Hau Lee
- Children's Intensive Care UnitKK Women's and Children's Hospital Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
| | - Yara M. F. Moreno
- Department of Nutrition and Postgraduate Program in NutritionSanta Catarina Federal UniversityHealth Sciences Centre Florianópolis Santa Catarina Brazil
| | - Nazima Pathan
- Addenbrooke's HospitalUniversity of Cambridge Cambridge England
| | - Sascha Verbruggen
- Pediatric Intensive Care UnitErasmus MC ‐ Sophia Children's Hospital Rotterdam the Netherlands
| | - Nilesh M. Mehta
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children's HospitalHarvard Medical School Boston Massachusetts USA
| |
Collapse
|
9
|
Martin B, Knight G, Sherriff J. Current enteral feeding practices in paediatric intensive care units in Australia and New Zealand: Results from a survey of dietitians. Nutr Diet 2018; 76:119-120. [PMID: 30259618 DOI: 10.1111/1747-0080.12476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/08/2018] [Accepted: 08/16/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Belinda Martin
- Nutrition and Dietetics, School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Geoff Knight
- Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Jill Sherriff
- Nutrition and Dietetics, School of Public Health, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
10
|
Hauschild DB, Oliveira LDA, Farias MS, Barbosa E, Bresolin NL, Mehta NM, Moreno YMF. Enteral Protein Supplementation in Critically Ill Children: A Randomized Controlled Pilot and Feasibility Study. JPEN J Parenter Enteral Nutr 2018; 43:281-289. [PMID: 29959852 DOI: 10.1002/jpen.1416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/04/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Loss of muscle mass in critically ill children can negatively impact outcomes. The aims of this study were to conduct a pilot randomized control trial (RCT) to examine the difference in protein delivery and nitrogen balance in critically ill children with enteral protein supplementation vs controls. We also aimed to assess the feasibility, safety, and tolerance of the pilot trial. METHODS This is a 3-arm RCT in critically ill children eligible for enteral nutrition (EN) therapy. Patients were randomized to 1 of the 3 groups: (1) control (routine EN), (2) polymeric protein module added to EN to reach protein goal by day 4, or (3) oligomeric protein supplementation. Demographics, clinical characteristics, nutrition status, and daily nutrition intake variables were recorded. Protein delivery, nitrogen balance, feasibility variables, and rate of adverse events were the outcomes. RESULTS After screening 286 consecutive patients admitted to the pediatric intensive care unit over 11 months, we enrolled and randomized 25 patients. Twenty-two patients (88% of the enrolled) completed the study procedures. Significantly higher protein prescription and actual protein intake within the first 5 days was achieved in the intervention groups, compared with the control group. Nitrogen balance was obtained in 15 patients. There was no significant difference between the groups for the rate of adverse effects and clinical outcomes. CONCLUSION In our pilot trial, protein supplementation was safe and well tolerated. Our preliminary results suggest that a larger RCT is potentially feasible, with some modifications of the entry criteria. Trial enrollment was low, likely due to restrictive entry criteria.
Collapse
Affiliation(s)
- Daniela B Hauschild
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Luna D A Oliveira
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Mirelle S Farias
- Nutrition, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
| | - Eliana Barbosa
- Nutrition, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
| | - Nilzete L Bresolin
- Pediatric Intensive Care Unit, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
| | - Nilesh M Mehta
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Yara M F Moreno
- Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| |
Collapse
|
11
|
The costs of disease related malnutrition in hospitalized children. Clin Nutr ESPEN 2018; 23:228-233. [DOI: 10.1016/j.clnesp.2017.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/10/2017] [Accepted: 09/26/2017] [Indexed: 11/24/2022]
|
12
|
Hulst JM, Joosten KF. Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition. J Acad Nutr Diet 2018; 118:33-36. [DOI: 10.1016/j.jand.2017.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/23/2017] [Indexed: 01/07/2023]
|
13
|
Use of Indirect Calorimetry to Detect Overfeeding in Critically Ill Children: Finding the Appropriate Definition. J Pediatr Gastroenterol Nutr 2016; 63:445-50. [PMID: 26998927 DOI: 10.1097/mpg.0000000000001197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Overfeeding during critical illness is associated with adverse effects such as metabolic disturbances and increased risk of infection. Because of the lack of sound studies with clinical endpoints, overfeeding is arbitrarily defined as the ratio caloric intake/measured resting energy expenditure (mREE) or alternatively as a comparison of measured respiratory quotient (RQ) to the predicted RQ based on the macronutrient intake (RQmacr). We aimed to compare definitions of overfeeding in critically ill mechanically ventilated children based on mREE, RQ, and caloric intake to find an appropriate definition. METHODS Indirect calorimetry measurements were performed in 78 mechanically ventilated children, median age 6.3 months. Enteral and/or parenteral nutrition was provided according to the local guidelines. Definitions used to indicate overfeeding were the ratio caloric intake/mREE of >110% and >120% and by the measured RQ > RQmacr + 0.05. RESULTS The proportion of patients identified as overfed varied widely depending on the definition used, ranging from 22% (RQ > RQmacr + 0.05), to 40% and 50% (caloric intake/mREE of >120% and >110%, respectively). Linear regression analysis showed that all patients would be identified as overfed with the definition RQ > RQmacr + 0.05 when the ratio caloric intake/mREE exceeded 165%. Caloric intake was higher in children with a standard deviation-score weight for age <-2. CONCLUSIONS The proportion of mechanically ventilated patients identified as overfed ranged widely depending on the definition applied. These currently used definitions fail to take into account several relevant factors affecting metabolism during critical illness and are therefore not generally applicable to the pediatric intensive care unit population.
Collapse
|