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Meoli M, Lava SAG, Bronz G, Goeggel-Simonetti B, Simonetti GD, Alberti I, Agostoni C, Bianchetti MG, Scoglio M, Vismara SA, Milani GP. Eu- or hypoglycemic ketosis and ketoacidosis in children: a review. Pediatr Nephrol 2024; 39:1033-1040. [PMID: 37584686 PMCID: PMC10899420 DOI: 10.1007/s00467-023-06115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023]
Abstract
The last decade has been characterized by exciting findings on eu- or hypoglycemic ketosis and ketoacidosis. This review emphasizes the following five key points: 1. Since the traditional nitroprusside-glycine dipstick test for urinary ketones is often falsely negative, the blood determination of β-hydroxybutyrate, the predominant ketone body, is currently advised for a comprehensive assessment of ketone body status; 2. Fasting and infections predispose to relevant ketosis and ketoacidosis especially in newborns, infants, children 7 years or less of age, and pregnant, parturient, or lactating women; 3. Several forms of carbohydrate restriction (typically less than 20% of the daily caloric intake) are employed to induce ketosis. These ketogenic diets have achieved great interest as antiepileptic treatment, in the management of excessive body weight, diabetes mellitus, and in sport training; 4. Intermittent fasting is more and more popular because it might benefit against cardiovascular diseases, cancers, neurologic disorders, and aging; 5. Gliflozins, a new group of oral antidiabetics inhibiting the renal sodium-glucose transporter 2, are an emerging cause of eu- or hypoglycemic ketosis and ketoacidosis. In conclusion, the role of ketone bodies is increasingly recognized in several clinical conditions. In the context of acid-base balance evaluation, it is advisable to routinely integrate both the assessment of lactic acid and β-hydroxybutyrate.
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Affiliation(s)
- Martina Meoli
- Family Medicine Institute, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Gabriel Bronz
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Barbara Goeggel-Simonetti
- Family Medicine Institute, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Giacomo D Simonetti
- Family Medicine Institute, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Ilaria Alberti
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Mario G Bianchetti
- Family Medicine Institute, Università Della Svizzera Italiana, 6900, Lugano, Switzerland.
| | - Martin Scoglio
- Family Medicine Institute, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Stefano A Vismara
- Family Medicine Institute, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
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D’Oria V, Spolidoro GCI, Agostoni CV, Montani C, Ughi L, Villa C, Marchesi T, Babini G, Scalia Catenacci S, Donà G, Guerrini M, Chidini G, Calderini E, Langer T. Validation of Indirect Calorimetry in Children Undergoing Single-Limb Non-Invasive Ventilation: A Proof of Concept, Cross-Over Study. Nutrients 2024; 16:230. [PMID: 38257123 PMCID: PMC10818402 DOI: 10.3390/nu16020230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The accurate assessment of resting energy expenditure (REE) is essential for personalized nutrition, particularly in critically ill children. Indirect calorimetry (IC) is the gold standard for measuring REE. This methodology is based on the measurement of oxygen consumption (VO2) and carbon dioxide production (VCO2). These parameters are integrated into the Weir equation to calculate REE. Additionally, IC facilitates the determination of the respiratory quotient (RQ), offering valuable insights into a patient's carbohydrate and lipid consumption. IC validation is limited to spontaneously breathing and mechanically ventilated patients, but it is not validated in patients undergoing non-invasive ventilation (NIV). This study investigates the application of IC during NIV-CPAP (continuous positive airway pressure) and NIV-PS (pressure support). METHODS This study was conducted in the Pediatric Intensive Care Unit of IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, between 2019 and 2021. Children < 6 years weaning from NIV were enrolled. IC was performed during spontaneous breathing (SB), NIV-CPAP, and NIV-PS in each patient. A Bland-Altman analysis was employed to compare REE, VO2, VCO2, and RQ measured by IC. RESULTS Fourteen patients (median age 7 (4; 18) months, median weight 7.7 (5.5; 9.7) kg) were enrolled. The REE, VO2, VCO2, and RQ did not differ significantly between the groups. The Limits of Agreement (LoA) and bias of REE indicated good agreement between SB and NIV-CPAP (LoA +28.2, -19.4 kcal/kg/day; bias +4.4 kcal/kg/day), and between SB and NIV-PS (LoA -22.2, +23.1 kcal/kg/day; bias 0.4 kcal/kg/day). CONCLUSIONS These preliminary findings support the accuracy of IC in children undergoing NIV. Further validation in a larger cohort is warranted.
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Affiliation(s)
- Veronica D’Oria
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | | | - Carlo Virginio Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Cinzia Montani
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Ludovica Ughi
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Cristina Villa
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.V.); (G.B.)
| | - Tiziana Marchesi
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Giovanni Babini
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.V.); (G.B.)
| | - Stefano Scalia Catenacci
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Giada Donà
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Marta Guerrini
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giovanna Chidini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Edoardo Calderini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Thomas Langer
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy
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Zamberlan P, Mazzoni BP, Bonfim MAC, Vieira RR, Tumas R, Delgado AF. Body composition in pediatric patients. Nutr Clin Pract 2023; 38 Suppl 2:S84-S102. [PMID: 37721465 DOI: 10.1002/ncp.11061] [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: 03/09/2023] [Revised: 06/26/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023] Open
Abstract
Undernutrition is highly prevalent in children who are critically ill and is associated with increased morbidity and mortality, including a higher risk of infection due to transitory immunological disorders, inadequate wound healing, reduced gut function, longer dependency on mechanical ventilation, and longer hospital stays compared with eutrophic children who are critically ill. Nutrition care studies have proposed that early interventions targeting nutrition assessment can prevent or minimize the complications of undernutrition. Stress promotes an acute inflammatory response mediated by cytokines, resulting in increased basal metabolism and nitrogen excretion and leading to muscle loss and changes in body composition. Therefore, the inclusion of body composition assessment is important in the evaluation of these patients because, in addition to the nutrition aspect, body composition seems to predict clinical prognosis. Several techniques can be used to assess body composition, such as arm measurements, calf circumference, grip strength, bioelectrical impedance analysis, and imaging examinations, including computed tomography and dual-energy x-ray absorptiometry. This review of available evidence suggests that arm measurements seem to be well-established in assessing body composition in children who are critically ill, and that bioelectrical impedance analysis with phase angle, handgrip strength, calf circumference and ultrasound seem to be promising in this evaluation. However, further robust studies based on scientific evidence are necessary.
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Affiliation(s)
- Patrícia Zamberlan
- Instituto da Criança e do Adolescente/Division of Nutrition, Support Team, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Beatriz P Mazzoni
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Maria A C Bonfim
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Rafaela R Vieira
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Rosana Tumas
- Instituto da Criança e do Adolescente/Nutrology Unit, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Artur F Delgado
- Department of Pediatrics - Medical School, Universidade de São Paulo, São Paulo, Brazil
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Vergara C, Del Pozo P, Niklitschek J, Le Roy C. Nutritional support in the critical ill patient: Requirements, prescription and adherence. An Pediatr (Barc) 2023; 99:94-101. [PMID: 37537114 DOI: 10.1016/j.anpede.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/22/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION In critically ill patients, nutritional support is a challenge in terms of both estimating their requirements and ensuring adherence to the prescribed treatment. OBJECTIVE To assess the association between requirements, prescription and adherence to energy and protein supplementation based on the phase of disease in critically ill patients. SAMPLE AND METHODS We conducted a prospective, observational and analytical study in patients aged 0-18 years admitted to the paediatric intensive or intermediate care unit in 2020-2021. We collected data on demographic and anthropometric characteristics and the phase of disease (acute phase [AP] vs. non-acute phase [nAP]), in addition to prescribing (P) (indication of nutritional support), basal metabolic rate (BMR, Schofield equation), adherence to nutritional support (A) and protein requirements (R), and calculated the following ratios: P/BMR, P/R, A/BMR, A/R, and A/P. RESULTS The sample included 131 participants with a median age of 16 (4.5) months, of who 128 (97.7%) had comorbidities and 13 (9.9%) were in the AP. Comparing the phases of disease (AP vs. nAP), the median values for energy supplementation were P/BMR, 0.5 (IQR, 0.1-1.4) vs. 1.3 (IQR, 0.9-1.8) (P = 0.0054); A/BMR, 0.4 (IQR, 0-0.6) vs. 1.2 (IQR, 0.8-1.7) (P = 0.0005); A/P, 0.7 (IQR, 0-0.9) vs. 1 (IQR, 0.8-1) (P = 0.002), and for protein were P/R, 0.7 (IQR, 0-1.1) vs. 1.2 (0.9-1.6) (P = 0.0009); A/R 0.3 (IQR, 0-0.6) vs. 1.1 (IQR, 0.8-1.5) (P = 0.0002); A/P 0.7 (IQR, 0-1) vs. 1(IQR, 0.8-1) (P = 0.002). We found AP/nAP ratios greater than 110% for energy in the P/BMR (4 patients [30.8%]/72 patients [61%]; P = 0.007), A/BMR (3 [23%]/63 [53.4%]; P = 0.009) and A/P (1 [7%]/3 [2.5%]; P = 0.007). As for protein, more than 1.5 g/kg/day was prescribed in 3 patients (23.1%) in the AP and 71 (60.1%) in the nAP. We found adherence to the prescribed intake in 2 (15.4%) patients in the AP and 66 (56%) in the nAP. We found a correlation coefficient of 0.6 between the energy P/R and the protein P/R. Prescribed support was discontinued in 7 patients (53.8%) in the AP and 31 (26.3%) in the nAP (P = 0.002). CONCLUSIONS The proportion of adherence to prescribed nutritional support was high in patients in the nAP of the disease. Overfeeding was frequent, more so in the nAP. We identified difficulties in adhering to prescribed support, chief of which was the discontinuation of feeding.
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Affiliation(s)
- Camila Vergara
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Del Pozo
- Unidad Académica de Cuidados Intensivos Pediátricos, Departamento de Pediatría, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jessie Niklitschek
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Le Roy
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Pediatría y Cirugía Infantil, Campus Centro, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Huang M, Yu Y, Tang X, Dong R, Li X, Li F, Jin Y, Gong S, Wang X, Zeng Z, Huang L, Yang H. 3-Hydroxybutyrate ameliorates sepsis-associated acute lung injury by promoting autophagy through the activation of GPR109α in macrophages. Biochem Pharmacol 2023; 213:115632. [PMID: 37263300 DOI: 10.1016/j.bcp.2023.115632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Sepsis is a systemic inflammatory disease caused by multiple pathogens, with the most commonly affected organ being the lung. 3-Hydroxybutyrate plays a protective role in inflammatory diseases through autophagy promotion; however, the exact mechanism remains unexplored. METHOD Our study used the MIMIC-III database to construct a cohort of ICU sepsis patients and figure out the correlation between the level of ketone bodies and clinical prognosis in septic patients. In vivo and in vitro models of sepsis were used to reveal the role and mechanism of 3-hydroxybutyrate in sepsis-associated acute lung injury (sepsis-associated ALI). RESULT Herein, we observed a strong correlation between the levels of ketone bodies and clinical prognosis in patients with sepsis identified using the MIMIC- III database. In addition, exogenous 3-hydroxybutyrate supplementation improved the survival rate of CLP-induced sepsis in mice by promoting autophagy. Furthermore, 3-hydroxybutyrate treatment protected against sepsis-induced lung damage. We explored the mechanism underlying these effects. The results indicated that 3-hydroxybutyrate upregulates autophagy levels by promoting the transfer of transcription factor EB (TFEB) to the macrophage nucleus in a G-protein-coupled receptor 109 alpha (GPR109α) dependent manner, upregulating the transcriptional level of ultraviolet radiation resistant associated gene (UVRAG) and increasing the formation of autophagic lysosomes. CONCLUSION 3-Hydroxybutyrate can serve as a beneficial therapy for sepsis-associated ALI through the upregulation of autophagy. These results may provide a basis for the development of promising therapeutic strategies for sepsis-associated ALI.
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Affiliation(s)
- Mingxin Huang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China
| | - Yiqin Yu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China
| | - Xuheng Tang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China
| | - Rui Dong
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China
| | - Xiaojie Li
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China
| | - Fen Li
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China
| | - Yongxin Jin
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China
| | - Shenhai Gong
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Xingmin Wang
- Department of Pathology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou 545001, China
| | - Zhenhua Zeng
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Lin Huang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China.
| | - Hong Yang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510665, China; The Third Clinical College of Southern Medical University, Guangzhou 510665, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510515, China.
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Zaher S, White D, Ridout J, Branco RG, Meyer R, Pathan N. The effect of nutritional status and inflammatory stimuli on Ghrelin and PYY levels among critically ill children: A prospective and observational study. JPEN J Parenter Enteral Nutr 2022; 46:1298-1306. [DOI: 10.1002/jpen.2339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sara Zaher
- Clinical Nutrition Department, Faculty of Applied Medical Sciences Taibah University Saudi Arabia
| | - Deborah White
- Department of Paediatrics University of Cambridge, Hills Road Cambridge UK
| | - Jenna Ridout
- Cambridge University Hospitals NHS Foundation Trust, Hills Road Cambridge UK
| | | | - Rosan Meyer
- Department Paediatrics, Imperial Collage London, UK/Department Nutrition and Dietetics, University of Winchester UK
| | - Nazima Pathan
- Department of Paediatrics University of Cambridge, Hills Road Cambridge UK
- Cambridge University Hospitals NHS Foundation Trust, Hills Road Cambridge UK
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Albadi MS, Bookari K. Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review. Front Pediatr 2022; 10:769401. [PMID: 35601420 PMCID: PMC9114497 DOI: 10.3389/fped.2022.769401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Undernutrition (UN) may negatively impact clinical outcomes for hospitalized patients. The relationship between UN status at pediatric intensive care unit (PICU) admission and clinical outcomes is still not well-reported. This systematic meta-analysis review evaluated the impact of UN at admission to PICU on clinical outcomes, including mortality incidence, length of stay (LOS), and the need for and length of time on mechanical ventilation (MV). METHODS A search was conducted using relevant and multi-medical databases from inception until January 2022. We considered studies that examined the link between UN at PICU admission and clinical outcomes in patients aged 18 years or younger. Pooled risk difference estimates for the PICU outcomes were calculated using a random-effects model. RESULT There were a total of 10,638 patients included in 17 observational studies; 8,044 (75.61%) and 2,594 (24.38%) patients, respectively, were normal-nourished (NN) and undernourished (UN). In comparison to NN patients, UN patients had a slightly higher risk of mortality (RD = 0.02, P = 0.05), MV usage (RD = 0.05, P = 0.02), and PICU LOS (RD = 0.07, P = 0.007). While the duration of MV was significantly longer in UN than in NN (RD = 0.13, P < 0.0001). Sensitivity analysis of UN classification cohorts with a z-score < -2 or in the 5%, patetints age up to 18 years, and mixed diagnose for PICU admission demonstrated a 6-fold increase in the probability of PICU LOS in UN patients compared to NN patients (RD = 0.06, 95% CI = 0.01, 0.12). UN patients have a higher risk of MV usage RD = 0.07, 95% CI = 0.00, 0.14) in studies involving cohorts with a mixed primary diagnosis for PICU admission. CONCLUSION In PICU, UN is linked to mortality incidence, longer PICU stay, MV usage, and duration on MV. The primary diagnosis for PICU admission may also influence clinical outcomes. Determining the prevalence of UN in hospitalized patients, as well as the subgroups of patients diagnosed at the time of admission, requires more research. This may help explain the relationship between nutritional status and clinical outcomes in PICU patients.
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Affiliation(s)
- Maram S Albadi
- Clinical Nutrition Department, Maternity and Children Hospital, Medina, Saudi Arabia.,Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
| | - Khlood Bookari
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
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Spolidoro GCI, D’Oria V, De Cosmi V, Milani GP, Mazzocchi A, Akhondi-Asl A, Mehta NM, Agostoni C, Calderini E, Grossi E. Artificial Neural Network Algorithms to Predict Resting Energy Expenditure in Critically Ill Children. Nutrients 2021; 13:nu13113797. [PMID: 34836053 PMCID: PMC8618974 DOI: 10.3390/nu13113797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Accurate assessment of resting energy expenditure (REE) can guide optimal nutritional prescription in critically ill children. Indirect calorimetry (IC) is the gold standard for REE measurement, but its use is limited. Alternatively, REE estimates by predictive equations/formulae are often inaccurate. Recently, predicting REE with artificial neural networks (ANN) was found to be accurate in healthy children. We aimed to investigate the role of ANN in predicting REE in critically ill children and to compare the accuracy with common equations/formulae. STUDY METHODS We enrolled 257 critically ill children. Nutritional status/vital signs/biochemical values were recorded. We used IC to measure REE. Commonly employed equations/formulae and the VCO2-based Mehta equation were estimated. ANN analysis to predict REE was conducted, employing the TWIST system. RESULTS ANN considered demographic/anthropometric data to model REE. The predictive model was good (accuracy 75.6%; R2 = 0.71) but not better than Talbot tables for weight. After adding vital signs/biochemical values, the model became superior to all equations/formulae (accuracy 82.3%, R2 = 0.80) and comparable to the Mehta equation. Including IC-measured VCO2 increased the accuracy to 89.6%, superior to the Mehta equation. CONCLUSIONS We described the accuracy of REE prediction using models that include demographic/anthropometric/clinical/metabolic variables. ANN may represent a reliable option for REE estimation, overcoming the inaccuracies of traditional predictive equations/formulae.
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Affiliation(s)
- Giulia C. I. Spolidoro
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (V.D.C.); (G.P.M.)
| | - Veronica D’Oria
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Anestesia e Terapia Intensiva Donna-Bambino, 20122 Milan, Italy; (V.D.); (E.C.)
| | - Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (V.D.C.); (G.P.M.)
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Gregorio Paolo Milani
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (V.D.C.); (G.P.M.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandra Mazzocchi
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Alireza Akhondi-Asl
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.A.-A.); (N.M.M.)
| | - Nilesh M. Mehta
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.A.-A.); (N.M.M.)
- Center for Nutrition, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (V.D.C.); (G.P.M.)
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Correspondence:
| | - Edoardo Calderini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Anestesia e Terapia Intensiva Donna-Bambino, 20122 Milan, Italy; (V.D.); (E.C.)
| | - Enzo Grossi
- Villa Santa Maria Foundation, Neuropsychiatric Rehabilitation Center, Autism Unit, 22038 Tavernerio, Italy;
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9
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Albert BD, Spolidoro GC, Mehta NM. Metabolism and energy prescription in critically III children. Minerva Anestesiol 2021; 87:1025-1033. [PMID: 33853268 DOI: 10.23736/s0375-9393.21.14825-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Optimal nutrition therapy can positively influence clinical outcomes in critically ill children. Accurate assessment of nutritional status, metabolic state, macronutrient requirements and substrate utilization allows accurate prescription of nutrition in this population. In response to stress and injury, the body undergoes adaptive physiologic changes leading to dysregulation of the inflammatory response and hyperactivation of the inflammatory cascade. This results in a global catabolic state with modification in oxygen consumption and macronutrient metabolism. A comprehensive understanding of the metabolic response is essential when prescribing nutritional interventions aimed to offset the burden of this adaptive stress response in the critically ill. In this narrative review we aim to provide a comprehensive review of the physiologic basis, recent literature and some emerging concepts related to energy expenditure and the practical aspects of energy delivery in the critically ill child. Based on the unique metabolic characteristics of the critically ill child, we aim to provide a pragmatic approach to providing nutrition therapy.
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Affiliation(s)
- Ben D Albert
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Giulia C Spolidoro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nilesh M Mehta
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA - .,Harvard Medical School, Cambridge, MA, USA.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Center for Nutrition, Boston Children's Hospital, Boston, MA, USA
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10
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Bruns N, Große Lordemann A, Rasche T, Meyburg J, Krüger M, Wieg C, Gratopp A, Hoppenz M, Heitmann F, Hoppen T, Löffler G, Felderhoff-Müser U, Dohna-Schwake C. Iatrogenic severe hyperglycemia due to parenteral administration of glucose in children - a case series. Ital J Pediatr 2020; 46:179. [PMID: 33261643 PMCID: PMC7709336 DOI: 10.1186/s13052-020-00939-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Iatrogenic severe hyperglycemia (ISH) caused by glucose-containing i.v. solution is a potentially fatal treatment error. The objective of this study was to investigate the causes, circumstances, course of disease, and complications of ISH > 300 mg/dl (16.7 mmol/l) in neonates and children. Methods We emailed a survey to 105 neonatal and pediatric intensive care units in Germany, Austria, and Switzerland, asking to retrospectively report cases of ISH. Results We received 11 reports about premature infants to children. Four patients (36%) had poor outcome: 2 died and 2 suffered persistent sequelae. The highest observed blood glucose was at median 983 mg/dl (54.6 mmol/l) (range 594–2240 mg/dl; 33.0–124.3 mmol/l) and median time to normoglycemia was 7 h (range 2–23). Blood glucose was higher and time to normoglycemia longer in patients with poor outcome. Invasive therapy was required in 73% (mechanical ventilation) and 50% (vasopressor therapy) of patients, respectively. Administration of insulin did not differ between outcome groups. Patients with poor outcome showed coma (100% vs. 40%) and seizures (75% vs. 29%) more frequently than those with good outcome. Conclusions ISH is a severe condition with high morbidity and mortality. Further research to amplify the understanding of this condition is needed, but focus should largely be held on its prevention.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Anja Große Lordemann
- Emergency Department, Children's Hospital Hamburg-Altona, Bleickenallee 38, 22763, Hamburg, Germany
| | - Tobias Rasche
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Jochen Meyburg
- Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Marcus Krüger
- Department of Neonatology, Munich Clinic Campus Harlaching and Schwabing, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Christian Wieg
- Department of Neonatology and Pediatric Intensive Care, Klinikum Aschaffenburg, Am Hasenkopf, 63739, Aschaffenburg, Germany
| | - Alexander Gratopp
- Division of Pediatric Emergency and Intensive Care Medicine, Charité University Medical Center, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marc Hoppenz
- Department of Neonatology and Pediatric Intensive Care Medicine, Children's Hospital, Amsterdamer Str. 59, 50735, Cologne, Germany
| | - Friedhelm Heitmann
- Department of Pediatrics, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Germany
| | - Thomas Hoppen
- Department of Pediatrics, Gemeinschaftsklinikum Mittelrhein, Koblenzer Str. 115-155, 56073, Koblenz, Germany
| | - Günther Löffler
- Department of Pediatric and Neonatal Intensive Care, University Hospital of Saarland, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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11
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Hauschild DB, Oliveira LDA, Ventura JC, Farias MS, Barbosa E, Bresolin NL, Moreno YMF. Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study. J Hum Nutr Diet 2020; 34:365-373. [PMID: 32767403 DOI: 10.1111/jhn.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS-ped) and to verify its association with clinical outcomes. METHODS A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS-ped, based on adult definition, was described. PICS-ped was defined as PICU length of stay >14 days; C-reactive protein > 10.0 mg L-1 ; lymphocytes <25%; and any reduction of mid-upper arm circumference Z-score. Clinical, demographic, nutritional status, nutrition therapy parameters and clinical outcomes were assessed. Statistical analysis comprised Mann-Whitney and Fisher's chi-squared tests, as well as logistic and Cox regression. P < 0.05 was considered statistically significant. RESULTS In total, 153 children were included, with a median age of 51.7 months (interquartile range 15.6-123.4 months), and 60.8% male. The mortality rate was 10.5%. The prevalence of PICS-ped was 4.6%. Days using vasoactive drugs and days using antibiotics were associated with PICS-ped. PICS-ped was associated with mortality in crude (odds ratio = 6.67; P = 0.013) and adjusted analysis (odds ratio = 7.14; P = 0.017). PICS-ped was also associated with PICU and hospital length of stay, as well as duration of mechanical ventilation. Similar results were found in a subset of critically ill children who required mechanical ventilation for more than 48 h. CONCLUSIONS Children with PICS-ped required antibiotics or vasoactive drugs for a longer period. PICS-ped was associated with poor clinical outcomes in critically ill children. More studies are needed to properly define PICS-ped for this population.
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Affiliation(s)
- D B Hauschild
- Nutrition Department, Federal University of Santa Catarina, Florianópolis, Brazil
| | - L D A Oliveira
- Federal University of Santa Catarina, Florianópolis, Brazil
| | - J C Ventura
- Federal University of Santa Catarina, Florianópolis, Brazil
| | - M S Farias
- Nutrition, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
| | - E Barbosa
- Nutrition, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
| | - N L Bresolin
- Pediatric Intensive Care Unit, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
| | - Y M F Moreno
- Federal University of Santa Catarina, Florianópolis, Brazil
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12
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Costa CAD, Mattiello R, Forte GC, Andrades GRH, Crestani F, Dalenogare IP, Einloft PR, Bruno F, Tonial CT, Garcia PCR. Clinical Outcomes in Critically Ill Children With Excess Weight: A Retrospective Cohort Study. Nutr Clin Pract 2020; 36:449-455. [PMID: 32618388 DOI: 10.1002/ncp.10541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of its high prevalence and negative impact on quality of life and longevity, overweight in childhood and adolescence is a major public health concern. The objective of the present study was to determine whether excess weight is associated with clinical outcomes in critically ill children and adolescents admitted to the pediatric intensive care unit (PICU). METHOD This retrospective cohort study was performed with children and adolescents admitted to a PICU over 3 years. Nutrition status was classified based on the body mass index z-score for age, following World Health Organization (WHO) criteria. The following outcomes were assessed: mortality, need for mechanical ventilation, length of admission, and multiple organ dysfunction syndrome. RESULTS Of 1468 patients admitted during the study period, 1407 were included in the study: 956 (68.0%) had adequate weight, 228 (16.2%) were overweight, and 223 (15.8%) were underweight. Associations were detected between most variables and all nutrition categories (underweight, adequate weight, and overweight). In the descriptive analysis, mortality was more prevalent in nutrition status extremes (extremely underweight or overweight). An independent association between nutrition status and mortality was not detected in any category. CONCLUSION Nutrition status was not independently associated with poor outcomes. However, overweight should be considered a potential risk factor for adverse clinical outcomes in PICU admissions.
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Affiliation(s)
- Caroline Abud Drumond Costa
- Post-graduate Program in Pediatrics and Child Health, School of Medicine, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Rita Mattiello
- Department of Pediatrics, Post-graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Gabriele Carra Forte
- Post-graduate Program in Pediatrics and Child Health, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Gabriela Rupp Hanzen Andrades
- Post-graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Francielly Crestani
- Post-graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | | | - Paulo Roberto Einloft
- Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Francisco Bruno
- Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Cristian Tedesco Tonial
- Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Pedro Celiny Ramos Garcia
- Department of Pediatrics, Post-graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.,Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.,Brazilian Council for Scientific and Technological Development (CNPq), Porto Alegre, RS, Brazil
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13
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Marino LV, Valla FV, Beattie RM, Verbruggen SCAT. Micronutrient status during paediatric critical illness: A scoping review. Clin Nutr 2020; 39:3571-3593. [PMID: 32371094 PMCID: PMC7735376 DOI: 10.1016/j.clnu.2020.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 01/06/2023]
Abstract
Background No evidence based recommendations for micronutrient requirements during paediatric critical illness are available, other than those arising from recommended nutrient intakes (RNI) for healthy children and expert opinion. Objectives The objective of this review is to examine the available evidence from micronutrient status in critically ill children considering studies which describe 1) micronutrient levels, 2) associations between micronutrient levels and clinical outcome, and 3) impact on clinical outcome with micronutrient supplementation during PICU admission. Design Scoping review. Eligibility criteria Any study which used a qualitative and quantitative design considering causes and consequences of micronutrient levels or micronutrient supplementation during paediatric critical illness. Sources of evidence NICE Healthcare Databases Advanced Search website (https://hdas.nice.org.uk/) was used as a tool for multiple searches, with a content analysis and charting of data extracted. Results 711 records were identified, 35 were included in the review. Studies evaluated serum micronutrient status was determined on admission day in majority of patients. A content analysis identified (n = 49) initial codes, (n = 14) sub-categories and (n = 5) overarching themes during critical illness, which were identified as: i) low levels of micronutrients, ii) causes of aberrant micronutrient levels, iii) associations between micronutrients levels and outcome, iv) supplementation of micronutrients. Conclusion During critical illness, micronutrients should be provided in sufficient amounts to meet reference nutrient intakes for age. Although, there is insufficient data to recommend routine supplementations of micronutrients at higher doses during critical illness, the ‘absence of evidence should not imply evidence of absence’, and well designed prospective studies are urgently needed to elucidate paediatric micronutrient requirements during critical illness. The absence of reliable biomarkers make it challenging to determine whether low serum levels are reflective of a true deficiency or as a result redistribution, particularly during the acute phase of critical illness. As more children continue to survive a PICU admission, particularly those with complex diseases micronutrient supplementation research should also be inclusive of the recovery phase following critical illness.
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Affiliation(s)
- L V Marino
- Department of Dietetics/Speech & Language Therapy, NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and School of Health Sciences, University of Southampton, Southampton, UK.
| | - F V Valla
- Paediatric Intensive Care Unit, Hôpital Femme Mère Enfant, CarMEN INSERM UMR 1060 Hospices Civils de Lyon, Lyon-Bron, France
| | - R M Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S C A T Verbruggen
- Intensive Care, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands
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14
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Zidorio AP, Togo C, Jones R, Dutra E, de Carvalho K. Resting Energy Expenditure and Protein Balance in People with Epidermolysis Bullosa. Nutrients 2019; 11:E1257. [PMID: 31163622 PMCID: PMC6627554 DOI: 10.3390/nu11061257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022] Open
Abstract
Epidermolysis bullosa (EB) is a group of conditions characterized by severe fragility of the skin that causes recurring blistering. The recessive dystrophic subtype of EB (RDEB) has a strong impact on the nutritional status. We evaluated the resting energy expenditure (REE) and presence of protein catabolism in patients with RDEB. REE was assessed in 10 subjects (7 females; age range 4-33 years) by indirect calorimetry and using a predictive equation. Nitrogen balance was calculated by protein intake and 24 h urinary urea excretion estimations. An assessment of body surface area (BSA) with infected and non-infected skin lesions was applied to the nitrogen balance burn equation that was adapted to EB. The REE values predicted by the equation were consistently lower than the ones measured, except for two subjects. All subjects recorded high protein and energy intake, with protein intake being higher than 4 g protein/kg/day for five subjects. Even so, protein catabolism was observed in six subjects, three of whom had infected wounds. This study raises the hypothesis that the clinical and nutritional risks of people with RDEB are associated with an increased REE and negative nitrogen balance, which reinforces the importance of nutritional support.
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Affiliation(s)
- Ana Paula Zidorio
- Graduate Program in Human Nutrition, Faculty of Health Science, University of Brasilia, Campus Universitário Darcy Ribeiro; Brasília 70910-900, Brazil.
| | - Camille Togo
- Graduate Program in Human Nutrition, Faculty of Health Science, University of Brasilia, Campus Universitário Darcy Ribeiro; Brasília 70910-900, Brazil.
| | - Rosie Jones
- Department of Dietetics, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
| | - Eliane Dutra
- Graduate Program in Human Nutrition, Faculty of Health Science, University of Brasilia, Campus Universitário Darcy Ribeiro; Brasília 70910-900, Brazil.
| | - Kenia de Carvalho
- Graduate Program in Human Nutrition, Faculty of Health Science, University of Brasilia, Campus Universitário Darcy Ribeiro; Brasília 70910-900, Brazil.
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15
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Salera S, Tadini G, Rossetti D, Grassi FS, Marchisio P, Agostoni C, Giavoli C, Rodari G, Guez S. A nutrition-based approach to epidermolysis bullosa: Causes, assessments, requirements and management. Clin Nutr 2019; 39:343-352. [PMID: 30857908 DOI: 10.1016/j.clnu.2019.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/23/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
Abstract
Inherited epidermolysis bullosa (EB) is a clinically and genetically heterogeneous group of rare diseases characterized by skin and mucous membrane fragility. EB primarily involves the skin and, in specific subtypes, the mucous membrane, resulting in complications which can strongly affect nutritional status (e.g. gastrointestinal complications, hand deformities, pain). The aims of nutritional support mainly include improving nutritional status, alleviating the stress of oral feeding and minimizing nutritional deficiencies, thus consequently improving growth, pubertal development, bowel function, immune status and wound healing. The aim of this review is to discuss knowledge of different aspects of the disease related to nutrition and growth.
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Affiliation(s)
- Simona Salera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy.
| | - Gianluca Tadini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy
| | - Donata Rossetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Francesca Sofia Grassi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Media Intensità di Cura, 20122, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy
| | - Claudia Giavoli
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinologia, 20122, Milano, Italy
| | - Giulia Rodari
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinologia, 20122, Milano, Italy
| | - Sophie Guez
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy
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16
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Oz HS. Nutrients, Infectious and Inflammatory Diseases. Nutrients 2017; 9:E1085. [PMID: 28973995 PMCID: PMC5691702 DOI: 10.3390/nu9101085] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 02/06/2023] Open
Abstract
A balanced diet with sufficient essential nutritional elements is critical for maintaining a healthy body.[...].
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Affiliation(s)
- Helieh S Oz
- Department of Physiology, Internal Medicine, College of Medicine, University of Kentucky Medical Center, Lexington, KY 40536-0298, USA.
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