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Fernández Montes R, Urbano Villaescusa J, Carrillo Álvarez Á, Vivanco Allende A, Solana García MJ, Díaz Coto S, Rey Galán C, López-Herce Cid J. Effect of three enteral diets with different protein contents on protein metabolism in critically ill infants: a randomized controlled trial. An Pediatr (Barc) 2023:S2341-2879(23)00120-5. [PMID: 37344303 DOI: 10.1016/j.anpede.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/06/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION The optimal intake to improve protein metabolism without producing adverse effects in seriously ill infants has yet to be established. The aim of our study was to analyse whether an increased protein intake delivered through enteral nutrition would be associated with an improvement in nitrogen balance and serum protein levels in critically ill infants. METHODS We conducted a multicentre, prospective randomized controlled trial (December 2016-June 2019). The sample consisted of critically ill infants receiving enteral nutrition assigned randomly to 3 protein content groups: standard diet (1.7 g/dL), protein-enriched diet (2.7 g/dL) and high protein-enriched diet (5.1 g/dL). Blood and urine tests were performed, and we assessed nitrogen balance at baseline and at 3-5 days of the diet. We analysed variations in nitrogen balance and serum protein levels (total protein, albumin, transferrin, prealbumin, and retinol-binding protein) throughout the study period. RESULTS Ninety-nine infants (33 per group) completed the study. We did not find any differences were between groups in demographic characteristics, severity scores or prescribed medications, except for corticosteroids, administered in a higher proportion of patients in the third group. We observed significant increases in prealbumin and retinol-binding protein levels in patients receiving the protein-enriched and high protein-enriched diets at 3-5 days compared to baseline. The nitrogen balance increased in all groups, but the differences were not significant in the high protein-enriched group. There were no differences in gastrointestinal tolerance. Patients fed high protein-enriched formula had higher levels of serum urea, with a higher incidence of hyperuraemia in this group. CONCLUSION Enteral administration of higher amounts of protein improves serum protein levels in critically ill children. A protein intake of 2.2 g/kg/day is generally safe and well tolerated, whereas an intake of 3.4 g/kg/day may produce hyperuraemia in some patients.
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Affiliation(s)
- Reyes Fernández Montes
- Unidad de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Javier Urbano Villaescusa
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángel Carrillo Álvarez
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Vivanco Allende
- Unidad de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María José Solana García
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Díaz Coto
- Departamento de Estadística, Investigación Operativa y Didáctica de la Matemática, Facultad de Ciencias, Universidad de Oviedo, Oviedo, Spain
| | - Corsino Rey Galán
- Unidad de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús López-Herce Cid
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, Madrid, Spain
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Fernández Montes R, Urbano Villaescusa J, Carrillo Álvarez Á, Vivanco Allende A, Solana García MJ, Díaz Coto S, Rey Galán C, López-Herce Cid J. Efecto de tres dietas enterales con diferente contenido en proteínas sobre el metabolismo proteico en lactantes críticamente enfermos: un ensayo clínico aleatorizado. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Abukari AS, Acheampong AK. Feeding the critically ill child in intensive care units: a descriptive qualitative study in two tertiary hospitals in Ghana. BMC Pediatr 2021; 21:395. [PMID: 34507534 PMCID: PMC8431941 DOI: 10.1186/s12887-021-02854-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Critically ill children require optimum feeding in the intensive care units for speedy recovery. Several factors determine their feeding and the feeding method to adopt to address this phenomenon. The aim of this study was to explore and describe the feeding criteria of critically ill children at the neonatal and paediatric intensive care units. METHODS A descriptive qualitative design was used to conduct the study. Six focus group discussions were conducted, and each group had five members. In addition, twelve one-on-one interviews were conducted in two public tertiary teaching hospitals in Ghana and analyzed by content analysis using MAXQDA Plus version 2020 qualitative software. Participants were selected purposively (N = 42). RESULTS The decision to feed a critically ill child in the ICU was largely determined by the child's medical condition as well as the experts' knowledge and skills to feed. It emerged from the data that cup feeding, enteral, parenteral, and breastfeeding were the feeding processes employed by the clinicians to feed the critically ill children. CONCLUSIONS Regular in-service training of clinicians on feeding critically ill children, provision of logistics and specialized personnel in the ICU are recommended to reduce possible infant and child mortality resulting from suboptimal feeding.
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Affiliation(s)
- Alhassan Sibdow Abukari
- School of Nursing, Wisconsin International University College-Ghana, P.O Box LG, Accra, Ghana
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