Nutrition Interventions to Optimize Pediatric Wound Healing

Abstract

Background and Objective: There is no accepted nutrition approach for wound healing in children. Our aims were to determine optimal nutrition support for pediatric wound healing. Methods: We applied local methods to create evidence- and consensus-based recommendations, supported by implementation tools, including algorithms, clinical decision supports, and measures. We applied these recommendations to the care of 49 patients from December 5, 2011, to December 5, 2012. Results: Six articles were found that addressed our clinical questions, and we formulated 5 clinical recommendations. Evidence supported evaluating patients for vitamin C, zinc, and protein deficiency. Of the patients where laboratory values were checked, 9 patients were zinc deficient (33%) and 12 patients were vitamin C deficient (48%). Discussion and Practical Application: The implementation of our recommendations has led to increased identification of micronutrient deficiencies and closer monitoring of nutrition status and intake. Online clinical decision supports can accelerate the adoption of clinical recommendations and reduce provider practice variation.

Optimizing Perioperative Nutrition in Pediatric Populations

“…For children who are malnourished, protein reserves may be limited, further increasing the protein needs after surgery 34 . Protein may be increased by 20%–25% if the wound is not healing as expected after a few days to a week after the child is consuming 100% of the initial estimated energy and protein needs 42 . In addition to protein, if there is a confirmed deficiency of vitamin C or zinc, then supplementation should be provided.…”

“…If a zinc deficiency is confirmed, then twice the RDA of zinc for age may be given and divided into 2 daily doses. The upper limit for vitamin C and zinc should not be exceeded, and supplementation should continue until the deficiency is normalized 42 . Two amino acids to take into consideration are glutamine and carnitine 6 .…”

Nutritional Management for Infants and Children Pre and Post-Liver Transplant

“…Wound issues such as presence of wound vacuum, non-healing wounds or infection, require nutrition assessment every 5-7 days to determine adequacy of nutrition support. It is important to provide additional protein at 1.5-2 x RDA with liberal calorie provision using the upper range of estimated energy needs [15]. Acute kidney injury may occur post liver transplant [16], requiring fluid restriction and influencing ability to meet nutrition goals, especially with feeding intolerance of concentrated formula.…”

“…For parenteral nutrition, vitamins are dosed according to recommendations in Table 6. Table 6 Parenteral nutrition vitamins for patients on continuous renal replacement therapy post liver transplant [15].…”

Identifying The Problems Experienced By Families Of Children With Burn Injuries After Discharge And The Causes Of These Problems

“…Burn management continues at home after discharge, and family members are the primarily responsible for it (8,9) . It has been reported that families experience difficulties and anxiety during this period (10)(11)(12) since the physical problems they expeirenced alter their daily life, effect family relationships, and the need for parental and family support emerges (13)(14)(15) . Families may feel alone in caring for the child and need professional support.…”