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Dadashi-Noshahr Y, Behzad A, Ahmadizadeh SN, Amirjani S, Vahdat Shariatpanahi Z. Nutritional status and clinical outcomes of brain tumor surgery in pediatric intensive care unit: A prospective cohort study. Clin Nutr ESPEN 2024; 61:302-307. [PMID: 38777448 DOI: 10.1016/j.clnesp.2024.03.029] [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: 03/07/2023] [Revised: 03/16/2024] [Accepted: 03/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND To determine whether nutritional status affects mortality and length of stay in the pediatric intensive care unit (PICU) after brain tumor surgery. METHODS Subjects aged 2 months to 13 years with brain tumor surgery were included in the study. Z-scores of BMI for age, weight for age, and weight for length were calculated at admission. Undernutrition was defined as Z-score < -2. Nutritional intake was measured daily by a clinical nutritionist. Outcomes to be measured included duration of hospitalization and mortality. Regression analyses was used to investigate the relationship between nutritional variables and outcomes. RESULTS A total of 63 patients met the inclusion criteria. Undernutrition at admission was found in 33% of subjects based on Z-scores of BMI and weight for length. The mortality rate was 17.5%. Calorie and protein intake was <50% of the target in 50.7% and 42.8 % of children, respectively. Undernutrition by weight for age Z-score, BMI for age and weight for length Z-scores, and low protein intake increased mortality risk by 5, 5.9 and 4.7 times, respectively. The risk of shorter PICU-free days was independently 80% and 90% lower in those receiving <50% of protein and calorie requirements. CONCLUSION Undernutrition at admission is prevalent in children undergoing brain tumor surgery and is associated with a higher risk of mortality. Caloric and protein intake during hospitalization is generally low, leading to longer PICU stay.
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Affiliation(s)
- Yasaman Dadashi-Noshahr
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Behzad
- Department of Critical Care, Mofid Children's Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Narjes Ahmadizadeh
- Department of Critical Care, Mofid Children's Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Amirjani
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Jotterand Chaparro C, Pabion C, Tume L, Mehta NM, Valla FV, Moullet C. Determining energy and protein needs in critically ill pediatric patients: A scoping review. Nutr Clin Pract 2023; 38 Suppl 2:S103-S124. [PMID: 37721467 DOI: 10.1002/ncp.11060] [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: 03/27/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION In critically ill pediatric patients, optimal energy and protein intakes are associated with a decreased risk of morbidity and mortality. However, the determination of energy and protein needs is complex. The objective of this scoping review was to understand the extent and type of evidence related to the methods used to determine energy and protein needs in critically ill pediatric patients. METHODS An international expert group composed of dietitians, pediatric intensivists, a nurse, and a methodologist conducted the review, based on the Johanna Briggs Institute methodology. Two researchers searched for studies published between 2008 and 2023 in two electronic databases, screened abstracts and relevant full texts for eligibility, and extracted data. RESULTS A total of 39 studies were included, mostly conducted in critically ill children undergoing ventilation, to assess the accuracy of predictive equations for estimating resting energy expenditure (REE) (n = 16, 41%) and the impact of clinical factors (n = 22, 56%). They confirmed the risk of underestimation or overestimation of REE when using predictive equations, of which the Schofield equation was the least inaccurate. Apart from weight and age, which were positively correlated with REE, the impact of other factors was not always consistent. No new indirect calorimeter method used to determine protein needs has been validated. CONCLUSION This scoping review highlights the need for scientific data on the methods used to measure energy expenditure and determine protein needs in critically ill children. Studies using a reference method are needed to validate an indirect calorimeter.
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Affiliation(s)
- Corinne Jotterand Chaparro
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Céline Pabion
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Lyvonne Tume
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Nilesh M Mehta
- Department of Anesthesiology, Critical Care and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frédéric V Valla
- Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Clémence Moullet
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
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Jotterand Chaparro C, Bertoni Maluf V, Moullet C, Kiszio B, Pugliese MT, Ramelet AS, Morice C, Valla FV, Tume LN. Effectiveness of high versus lower enteral protein intake, considering energy intake, on clinical outcomes in critically ill children: a systematic review protocol. JBI Evid Synth 2023:02174543-990000000-00155. [PMID: 37114868 DOI: 10.11124/jbies-22-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE The objective of this review is to evaluate the effectiveness of high versus lower enteral protein intake, considering energy intake, on clinical and nutritional outcomes in critically ill children hospitalized in the pediatric intensive care unit. INTRODUCTION Over and undernutrition increases the risk of morbidity and mortality in critically ill children. The impact of high versus lower enteral protein intake on clinical outcomes, considering energy intake, still needs to be investigated in children of different ages. INCLUSION CRITERIA This review will consider studies of critically ill children (aged between ≥ 37 wk' gestational age and < 18 y) admitted to the pediatric intensive care unit for a minimum of 48 hours and receiving enteral nutrition. Randomized controlled trials comparing high versus lower enteral protein intake, considering energy intake, will be eligible. Primary outcomes will include clinical and nutritional outcomes, such as length of stay in the pediatric intensive care unit and nitrogen balance. METHODS Using the JBI methodology for systematic reviews of effectiveness, we will search for randomized controlled trials published in English, French, Italian, Spanish, and German in electronic databases, including MEDLINE, CINAHL Complete, Embase, and the Cochrane Library, from database inception until the present. We will also search clinical trial registers and, if required, contact authors. Two independent reviewers will screen and select studies for inclusion, data extraction, and assessment of methodological quality. A third reviewer will be consulted if necessary. A statistical meta-analysis will be performed if feasible. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42022315325.
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Affiliation(s)
- Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Valeria Bertoni Maluf
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Clémence Moullet
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Blanche Kiszio
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Marie-Thérèse Pugliese
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Anne-Sylvie Ramelet
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Switzerland
- Lausanne University Hospital, Lausanne, Switzerland
| | - Claire Morice
- Pediatric Intensive Care Unit, Hôpital Universitaire Femme Mère Enfant, Hospices Civils de Lyon, France
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Frédéric V Valla
- Pediatric Intensive Care Unit, Hôpital Universitaire Femme Mère Enfant, Hospices Civils de Lyon, France
| | - Lyvonne N Tume
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
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Brown AM, Irving SY, Pringle C, Allen C, Brown MF, Nett S, Singleton MN, Mikhailov TA, Madsen E, Srinivasan V, Anthony H, Forbes ML. Bolus Gastric Feeds Improve Nutritional Delivery to Mechanically Ventilated Pediatric Medical Patients: Results of the COntinuous vs BOlus (COBO2) Multi-Center Trial. JPEN J Parenter Enteral Nutr 2021; 46:1011-1021. [PMID: 34881440 DOI: 10.1002/jpen.2305] [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] [Received: 01/20/2021] [Revised: 09/28/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Comparison of bolus (BGF) versus continuous gastric feeding (CGF) with respect to timing and delivery of energy and protein in mechanically ventilated pediatric patients has not been investigated. We hypothesized that bolus delivery would shorten time to goal nutrition and increase the percentage of goal feeds delivered. METHODS Multi-center, prospective, randomized comparative effectiveness trial conducted in seven Pediatric ICUs (PICUs). Eligibility criteria: 1 month - 12 years of age, intubated within 24 hours of PICU admission, expected duration of ventilation at least 48 hours, eligible to begin enteral nutrition within 48 hours. EXCLUSION CRITERIA acute or chronic gastrointestinal pathology, or acute surgery. RESULTS We enrolled 158 mechanically ventilated children between October 2015 and April 2018; 147 patients were included in the analysis (BGF = 72, CGF = 75). The BGF group was slightly older than CGF, otherwise the two groups had similar demographic characteristics. There was no difference in the percentage of patients in each group that achieved goal feeds. Time to goal feeds was shorter in the BGF [Hazard Ratio 1.5 (CI 1.02-2.33); P = 0.0387]. Median percentage of target kilocalories [median kcal 0.78 vs 0.59; p = <.0001], and median percentage of protein delivered [median pro 0.77 vs 0.59; p = <.0001] was higher for BGF patients. There was no difference in serial oxygen saturation index between groups. CONCLUSION Our study demonstrated shorter time to achieve goal nutrition via BGF compared to CGF in mechanically ventilated pediatric patients. This resulted in increased delivery of target energy and nutrition. Further study is needed in other PICU populations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ann-Marie Brown
- Associate Clinical Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Nurse Scientist, Children's Healthcare of Atlanta, Atlanta, GA
| | - Sharon Y Irving
- Associate Professor, Pediatric Nursing, Vice-Chair Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Charlene Pringle
- Pediatric Acute Care Nurse Practitioner, Division of Pediatric Critical Care Medicine, University of Florida, UFHealth Shands Children's Hospital, Gainesville, FL
| | - Christine Allen
- Associate Professor o Pediatrics, Division of Pediatric Critical Care, University of Oklahoma Health Sciences Center, The Children's Hospital at OU Health, Oklahoma City, OK
| | - Miraides F Brown
- Biostatistician, Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH
| | - Sholeen Nett
- Associate Professor, Division of Pediatric Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH and Baystate Children's Hospital, Springfield, MA
| | - Marcy N Singleton
- Pediatric Acute Care Nurse Practitioner, Dartmouth Hitchcock Medical Center, Instructor in Pediatrics Geisel School of Medicine
| | - Theresa A Mikhailov
- Professor of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Pediatric Intensivist, Children's Wisconsin, Milwaukee, WI
| | - Erik Madsen
- Assistant Professor of Pediatrics, Division of Pediatric Critical Care, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Vijay Srinivasan
- Assistant Professor of Anesthesiology, Critical Care and Pediatrics, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Attending Pediatric Intensivist, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather Anthony
- Clinical Research Support Team Supervisor, GAMUT Program Coordinator, Clinical Research Nurse, Akron Children's Hospital, Akron, OH
| | - Michael L Forbes
- Professor of Pediatrics, Northeast Ohio Medical University, Associate Chair, Department of Pediatrics, Director, Hospital-Based Medical Practices, Director, Critical Care Research & Outcomes Analysis, Akron Children's Hospital, Akron, OH
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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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Chwals WJ. Commentary regarding the impact of malnutrition (nutritional imbalance) on pediatric surgical outcome. J Pediatr Surg 2021; 56:446-448. [PMID: 33243466 DOI: 10.1016/j.jpedsurg.2020.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Walter J Chwals
- Tufts University, School of Medicine, Surgeon-in-Chief, Tufts Children's Hospital, Director, Kiwanis Pediatric Trauma Institute, 800 Washington Street, #344, Boston, MA 02111, USA.
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Knight DE, Larmour K, Wellman P, Mulvey N, Hopkins J, Tibby SM. Prospective evaluation of a novel enteral feeding guideline based on individual gastric emptying times: an improvement project in a pediatric intensive care unit. JPEN J Parenter Enteral Nutr 2021; 45:1720-1728. [PMID: 33475176 DOI: 10.1002/jpen.2077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND On a 20-bed, mixed cardiac and general, UK pediatric intensive care unit (PICU), we aimed to determine if a physiologically based enteral feeding guideline for critically ill children, using feed frequency tailored to individual gastric emptying times, resulted in earlier establishment of full feeds (when 100% of fluid allowance (FA) available to be given as intravenous maintenance fluid or feed, defined as free FA [FFA], is given as enteral nutrition [EN]) and an increase in FFA given as EN. METHODS Four prospective audits (totaling 331 patients and 19,771 hours) were conducted at 1 year before guideline introduction and 1, 5, and 10 years after. Patient feeding data were collected from admission until day 4 or discharge, including reasons why feed was withheld. RESULTS The median time from admission to establishing full feeds decreased from 18 to 10 hours preguideline and postguideline and was sustained over 10 years. After adjustment for 5 confounders, this represented a reduction in the geometric mean time to full feeds of 30% (2009), 29% (2013), and 48% (2019) compared with 2007 (all P < .01). Nil-per-oral (NPO) hours were categorized as due to modifiable and nonmodifiable factors. Preguideline and postguideline NPO hours from modifiable factors decreased from 21 (2007) to 10 (2009) per 100 audit hours, which was sustained across 10 years (all P < .01). Conversely, NPO hours from nonmodifiable factors ranged from 27 to 36 per 100 audit hours throughout the audits, with no consistent trend over time. Similar inconsistency was shown in the proportion of FFA given as EN: 48% (2007), 71% (2009), 51% (2013), and 64% (2019). Continuous nasogastric and hourly bolus feeds decreased over time; they comprised 66% of feeds in 2007 but only 4%-11% in subsequent periods, being replaced with more 2-6 hour bolus, on-demand, or continuous nasojejunal feeds. CONCLUSION The guideline was associated with sustained reduction in the time to establishing full feeds and NPO hours due to modifiable factors and more or no less FFA being given as EN.
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Affiliation(s)
- Dawn E Knight
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Kelly Larmour
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Paul Wellman
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Nicki Mulvey
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Julia Hopkins
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Shane M Tibby
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
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Huang XJ, Guo FF, Li F, Zhao JC, Fan YZ, Wang N, Qiao JY. [Nutritional support in children with pneumonia on mechanical ventilation by short-peptide enteral nutrition formula]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1209-1214. [PMID: 33172557 PMCID: PMC7666392 DOI: 10.7499/j.issn.1008-8830.2006101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To observe the incidence of malnutrition and nutritional risk in children with pneumonia on mechanical ventilation in the pediatric intensive care unit (PICU), and to explore the nutritional support effect of short-peptide enteral nutrition formula. METHODS A total of 68 children with severe pneumonia who were hospitalized in the PICU from October 2017 to October 2018 and required mechanical ventilation were enrolled for a prospective randomized controlled study. The children were randomly divided into a control group and an experimental group. Through the nasogastric feeding tube, the experimental group received the short-peptide enteral nutrition formula, and the control group received the intact-protein enteral nutrition formula. The weight-for-age Z score, STRONGkids nutritional risk score, and pediatric critical illness score of the two groups were evaluated. The serum levels of total protein, albumin, and prealbumin (PA) on admission and before discharge were measured. The gastrointestinal tolerance and clinical outcome indicators of the two groups were observed. RESULTS Among the 68 mechanically ventilated children, 26 (38%) had malnutrition, including moderate malnutrition (10 cases, 15%) and severe malnutrition (16 cases, 24%); 10 cases (15%) had malnutrition at discharge. Sixty-three children (93%) had nutritional risk, including moderate nutritional risk in 21 cases and high nutritional risk in 42 cases. The moderate and high nutritional risk rates of the critical and extreme critical groups were significantly higher than those of the non-critical group (P<0.05). Compared with the control group, the experimental group had significantly shorter duration of mechanical ventilation and total length of hospital stay, significantly higher serum PA level and weight growth rate, and significantly better gastrointestinal tolerance (P<0.05). There were no significant differences in the incidence of ventilator-associated pneumonia and disease outcome between the two groups (P>0.05). CONCLUSIONS The detection rates of malnutrition and nutritional risk in children with pneumonia on mechanical ventilation are relatively high. Short-peptide enteral nutrition formula can help improve their treatment outcome and are more suitable for nutritional support in critically ill children on mechanical ventilation.
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Affiliation(s)
- Xian-Jie Huang
- Department of Pediatric Intensive Care Unit, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Protein intake deficiency in critically ill children with respiratory insufficiency: A call to action? Clin Nutr ESPEN 2020; 37:69-74. [DOI: 10.1016/j.clnesp.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/05/2020] [Accepted: 03/20/2020] [Indexed: 11/21/2022]
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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.
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van Puffelen E, Jacobs A, Verdoorn CJM, Joosten KFM, van den Berghe G, Ista E, Verbruggen SCAT. International survey of De-implementation of initiating parenteral nutrition early in Paediatric intensive care units. BMC Health Serv Res 2019; 19:379. [PMID: 31196076 PMCID: PMC6567488 DOI: 10.1186/s12913-019-4223-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/06/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Initiating parenteral nutrition (PN) within 24 h in critically ill children is inferior to withholding PN during the first week, as was found in the PEPaNIC study. The aims of this study were to investigate de-implementation of early initiation of PN at PICUs worldwide, and to identify factors influencing de-implementation. METHODS A cross-sectional online survey was conducted (May - October 2017), consisting of 41 questions addressing current PN practices, the degree of de-implementation, and factors affecting de-implementation. RESULTS We analysed 81 responses from 39 countries. Of these 81 respondents, 53 (65%) were aware of the findings of the PEPaNIC study, and 43 (53%) have read the article. In these 43 PICUs, PN was completely withheld during the first week in 10 PICUs, of which 5 already withheld PN (12%), and 5 de-implemented early initiation of PN (12%). Partial de-implementation was reported by 17 (40%) and no de-implementation by 16 (37%). Higher de-implementation rates were observed when the interpreted level of evidence and grade of recommendation of PEPaNIC was high. Predominant reasons for retaining early initiation of PN were concerns on withholding amino acids, the safety in undernourished children and neonates, and the long-term consequences. Furthermore, the respondents were waiting for updated guidelines. CONCLUSIONS One year after the publication of the PEPaNIC trial, only two-thirds of the respondents was aware of the study results. Within this group, early initiation of PN was de-implemented completely in 12% of the PICUs, while 40% asserted partial de-implementation. Increasing the awareness, addressing the intervention-specific questions and more frequently revising international guidelines might help to accelerate de-implementation of ineffective, unproven or harmful healthcare.
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Affiliation(s)
- Esther van Puffelen
- Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - An Jacobs
- Department of Cellular and Molecular Medicine, Clinical Division and Laboratory of Intensive Care Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - Charlotte J. M. Verdoorn
- Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Koen F. M. Joosten
- Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Greet van den Berghe
- Department of Cellular and Molecular Medicine, Clinical Division and Laboratory of Intensive Care Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - Erwin Ista
- Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Department of Internal Medicine, Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sascha C. A. T. Verbruggen
- Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
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Carbone JW, Pasiakos SM. Dietary Protein and Muscle Mass: Translating Science to Application and Health Benefit. Nutrients 2019; 11:nu11051136. [PMID: 31121843 PMCID: PMC6566799 DOI: 10.3390/nu11051136] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022] Open
Abstract
Adequate consumption of dietary protein is critical for the maintenance of optimal health during normal growth and aging. The current Recommended Dietary Allowance (RDA) for protein is defined as the minimum amount required to prevent lean body mass loss, but is often misrepresented and misinterpreted as a recommended optimal intake. Over the past two decades, the potential muscle-related benefits achieved by consuming higher-protein diets have become increasingly clear. Despite greater awareness of how higher-protein diets might be advantageous for muscle mass, actual dietary patterns, particularly as they pertain to protein, have remained relatively unchanged in American adults. This lack of change may, in part, result from confusion over the purported detrimental effects of higher-protein diets. This manuscript will highlight common perceptions and benefits of dietary protein on muscle mass, address misperceptions related to higher-protein diets, and comment on the translation of academic advances to real-life application and health benefit. Given the vast research evidence supporting the positive effects of dietary protein intake on optimal health, we encourage critical evaluation of current protein intake recommendations and responsible representation and application of the RDA as a minimum protein requirement rather than one determined to optimally meet the needs of the population.
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Affiliation(s)
- John W Carbone
- School of Health Sciences, Eastern Michigan University, Ypsilanti, MI 48197, USA.
| | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, USA.
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Carvalhal FB, Ferreira Peres WA, Fontes Lima GC, Barcellos LH, do Carmo CN, de Carvalho Padilha P. Impact of energy deficit during hospitalization and biomarkers at admission on clinical outcomes in critically ill children: A longitudinal study. Clin Nutr ESPEN 2019; 32:70-75. [PMID: 31221293 DOI: 10.1016/j.clnesp.2019.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/23/2019] [Accepted: 04/29/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND & AIMS To evaluate the impact of energy deficit during hospitalization and the biomarkers albumin and C-reactive protein (CRP) on the clinical outcomes length of stay (LOS) and duration of mechanical ventilation (DMV) in children and adolescents admitted to the pediatric intensive care unit (PICU) of a private hospital in Rio de Janeiro. METHODS A longitudinal, retrospective study was conducted of the medical records of patients admitted to the PICU from May 2016 to June 2017 who received enteral nutrition (EN) for 72 h or longer. The cut-off points for serum albumin and CRP were set at ≥3.5 and <2.0, respectively. The energy balance was calculated as the difference between the energy prescribed and the energy received by the patient. The comparison of continuous variables related to LOS and DMV was assessed using Student's t-test and the Mann-Whitney test. The significance value was set at p < 0.05. RESULTS Ninety-three patients were selected, with a median age of 32 (±39.49) months. The mean serum albumin and CRP levels were 4.04 (±0.59) and 4.67 (±7.40), respectively. In linear regression models adjusted for length of stay, reduced albumin, increased CRP, and negative energy balance were positively associated. In the models adjusted to DMV, the values for reduced albumin and increased CRP were significant. CONCLUSION A significant association was found between serum albumin and CRP at admission and the outcomes under investigation, LOS and DMV. Energy deficit was also associated with LOS.
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Affiliation(s)
- Fernanda Barros Carvalhal
- Universidade Federal do Rio de Janeiro, Instituto de Nutrição Josué de Castro, Programa de Pós-graduação em Nutrição, Programa de Pós-graduação em Nutrição Clínica, Brazil.
| | - Wilza Arantes Ferreira Peres
- Universidade Federal do Rio de Janeiro, Instituto de Nutrição Josué de Castro, Programa de Pós-graduação em Nutrição, Programa de Pós-graduação em Nutrição Clínica, Brazil
| | - Géssica Castor Fontes Lima
- Universidade Federal do Rio de Janeiro, Instituto de Nutrição Josué de Castro, Programa de Pós-graduação em Nutrição, Programa de Pós-graduação em Nutrição Clínica, Brazil
| | - Luiza Hippler Barcellos
- Instituto Brasileiro de Medicina de Reabilitação, Laureate International Universities, Brazil
| | | | - Patrícia de Carvalho Padilha
- Universidade Federal do Rio de Janeiro, Instituto de Nutrição Josué de Castro, Programa de Pós-graduação em Nutrição, Programa de Pós-graduação em Nutrição Clínica, Brazil
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