Nutrition in Pediatric Intensive Care: A Narrative Review

Kratochvíl, Milan; Klučka, Jozef; Klabusayová, Eva; Musilová, Tereza; Vafek, Václav; Skříšovská, Tamara; Djakow, Jana; Havránková, Pavla; Osinová, Denisa; Štourač, Petr

doi:10.3390/children9071031

Cited by 4 publications

(5 citation statements)

References 47 publications

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“…Gastrointestinal tolerance to EN may be improved with a modification to the formula composition, a change in mode or route of administration, or the use of medications to treat constipation and delayed gastric motility. 72 Maximizing the benefits and tolerance of EN for patients with critical illness may also be aided with use of an EN protocol, as reviewed in Table 7, although these outcomes require multidisciplinary support and routine use of the guideline. EN algorithms were only used by 9 of 31 PICUs in a multicenter study and use had no association with EN adequacy.…”

Section: Practical Strategies For Timing Nutrition Support In the Picumentioning

confidence: 99%

“…Nutrition support for infants with critical illness is typically initiated with a standard concentration of human milk or infant formula of 67 kcal/100 ml. 72 Once target EN volume or fluid limit is met, energy density can be increased and protein supplements added to provide the target intake. With this strategy, infants required a significantly longer period of time to achieve goal protein and energy intake compared with children receiving a 100 kcal/100 ml pediatric formula.…”

Section: Barriers To Enteral Nutrition Barriers To Parenteral Nutritionmentioning

confidence: 99%

“…Nutrition support for infants with critical illness is typically initiated with a standard concentration of human milk or infant formula of 67 kcal/100 ml 72 . Once target EN volume or fluid limit is met, energy density can be increased and protein supplements added to provide the target intake.…”

Section: Practical Strategies For Timing Nutrition Support In the Picumentioning

confidence: 99%

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Timing of enteral nutrition and parenteral nutrition in the PICU

Fell,

Bitetto,

Skillman

2023

Nut in Clin Prac

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The timing of nutrition support initiation has the potential to positively impact nutrition and clinical outcomes in infants and children with critical illness. Early enteral nutrition within 24–48 h and attainment of both a 60% energy and protein goal by the end of the first week of pediatric intensive care unit admission are reported to be significantly associated with improved survival in large observational studies. The results of one randomized controlled trial demonstrated increased morbidity in infants and children with critical illness assigned to early vs delayed supplemental parenteral nutrition. Observational studies in this population also suggest increased mortality with exclusive parenteral nutrition and worse nutrition outcomes when parenteral nutrition is delayed. Subsequently, current nutrition support guidelines recommend early enteral nutrition and avoidance of early parenteral nutrition, although the available evidence used to create the guidelines was inadequate to inform bedside nutrition support practice to improve outcomes. These guidelines are limited by the included studies with small numbers and heterogeneity of patients and research design that confound study outcomes and interpretation. This article provides a narrative review of the timing of nutrition support on outcomes in infants and children with critical illness, strategies to optimize timing and adequacy of nutrition support, and literature gaps, including the timing of parenteral nutrition initiation for children with malnutrition and those with contraindications to enteral nutrition and accurate measurement of energy requirements.

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Section: Practical Strategies For Timing Nutrition Support In the Picumentioning

confidence: 99%

Section: Barriers To Enteral Nutrition Barriers To Parenteral Nutritionmentioning

confidence: 99%

Section: Practical Strategies For Timing Nutrition Support In the Picumentioning

confidence: 99%

See 1 more Smart Citation

Timing of enteral nutrition and parenteral nutrition in the PICU

Fell,

Bitetto,

Skillman

2023

Nut in Clin Prac

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“…The oral route (breastfeeding in infancy) is the preferred method of EN. 151 Other forms include gastric or postpyloric tube feeding. Nasogastric tube feeding is preferred in patients with swallowing difficulties, impaired consciousness, or under deep sedation.…”

Section: Route and Timing Of Nutritional Support (Clinical Practice P...mentioning

confidence: 99%

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations

Raina,

Suchan,

Sethi

et al. 2023

Kidney360

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Background: Nutrition plays a vital role in the outcome of critically ill children, particularly those with acute kidney injury (AKI). Currently, there are no established guidelines for children with AKI treated with continuous kidney replacement therapy (CKRT). A thorough understanding of the metabolic changes and nutritional challenges in AKI and CKRT is required. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with AKI receiving CKRT. Methods: PubMed, MEDLINE, Cochrane, and EMBASE databases were searched for articles related to the topic. Expertise of the authors and a consensus of the workgroup were additional sources of data in the article. Available articles on nutrition therapy in pediatric patients receiving CKRT through January 2023. Results: Based on the literature review, the current evidence base was examined by a panel of experts in pediatric nephrology and nutrition. The panel utilized the literature review as well as their expertise to formulate clinical practice points. The modified Delphi method was used to identify and refine clinical practice points. Conclusions: Forty-four clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with AKI and on CKRT based on the existing literature and expert opinions of a multidisciplinary panel.

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“…Prolonged PICU stay and hospitalization, as well as increased healthcare costs, underline the detrimental impact of malnutrition on patients’ health status and the public health systems, respectively [ 3 , 4 ]. Moreover, an excessive caloric delivery may be baneful in the acute phase of critical illness due to inefficient substrate use [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review

et al. 2023

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Administration of enteral nutrition (EN) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) constitutes a major challenge due to the increased risk of complications, as well as the lack of well-trained healthcare professionals. EN is usually delivered via cyclic, continuous, or intermittent feeding; however, a number of potential barriers have been reported in the literature regarding different feeding regimens. The purpose of this review was to assess the effectiveness of continuous and intermittent bolus feeding on critically ill children. A systematic search was conducted in PubMed, Scopus Cochrane Central Register of Controlled Trials (CENTRAL) and a clinical trial registry up to September 2022, including randomized controlled trials (RCTs) published in the English language. Four studies met the inclusion criteria with a total population of 288 patients admitted to the PICU. Three studies were rated with a high risk of bias and one with some concerns. There was high heterogeneity between the studies in regard to the reporting of outcomes. Three studies measured the total time needed to reach prescribed caloric intake with conflicting results, while two studies evaluated the length of stay (LOS) in PICU with no difference between the two arms. One study assessed the time weaning from mechanical ventilation, favoring the bolus group. No data were provided for gastric residual volume (GRV), anthropometric measurements, and biochemical markers. Additional randomized trials with better methodology are needed to assess the efficacy of the two enteral feeding regimens in critically ill PICU patients.

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Nutrition in Pediatric Intensive Care: A Narrative Review

Cited by 4 publications

References 47 publications

Timing of enteral nutrition and parenteral nutrition in the PICU

Timing of enteral nutrition and parenteral nutrition in the PICU

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations

Continuous versus Intermittent Enteral Feeding in Critically Ill Children: A Systematic Review

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