Nutritional support for critically ill children

Joffe, Ari R.; Anton, Natalie; Hartling, Lisa; Lequier, Laurance; Vandermeer, Ben; Tjosvold, Lisa; Larsen, Bodil

doi:10.1002/14651858.cd005144

Cited by 33 publications

(40 citation statements)

References 25 publications

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“…180 There is a paucity of data on nutrition support for the critically ill child, which remains a controversial topic. 182,183 One randomized controlled trial of an arginine/glutamine-fortified formula in 40 ventilated pediatric patients with traumatic brain injury showed no difference in outcomes compared with standard formula, but with a sample size of 20 children per arm, the study was insufficiently powered to answer questions on mortality and other clinical outcomes. In this study, nitrogen balance by day 5 became positive in 69.2% vs 30.8% of children who received immunonutrition vs regular formula, respectively (P < .05).…”

Section: Arginine Supplementationmentioning

confidence: 99%

Acquired Amino Acid Deficiencies: A Focus on Arginine and Glutamine

et al. 2017

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Nonessential amino acids are synthesized de novo and therefore not diet dependent. In contrast, essential amino acids must be obtained through nutrition since they cannot be synthesized internally. Several nonessential amino acids may become essential under conditions of stress and catabolic states when the capacity of endogenous amino acid synthesis is exceeded. Arginine and glutamine are 2 such conditionally essential amino acids and are the focus of this review. Low arginine bioavailability plays a pivotal role in the pathogenesis of a growing number of varied diseases, including sickle cell disease, thalassemia, malaria, acute asthma, cystic fibrosis, pulmonary hypertension, cardiovascular disease, certain cancers, and trauma, among others. Catabolism of arginine by arginase enzymes is the most common cause of an acquired arginine deficiency syndrome, frequently contributing to endothelial dysfunction and/or T-cell dysfunction, depending on the clinical scenario and disease state. Glutamine, an arginine precursor, is one of the most abundant amino acids in the body and, like arginine, becomes deficient in several conditions of stress, including critical illness, trauma, infection, cancer, and gastrointestinal disorders. At-risk populations are discussed together with therapeutic options that target these specific acquired amino acid deficiencies.

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Section: Arginine Supplementationmentioning

confidence: 99%

Acquired Amino Acid Deficiencies: A Focus on Arginine and Glutamine

et al. 2017

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“…In the paediatric literature, commonly accepted criteria for nutritional intervention (Table 1) are not evidence based (4,11), and the objectives of EN depend on the clinical condition of the patient (12)(13)(14). Specific clinical situations for which paediatric EN may be required are listed in Table 2 (5,11,(15)(16)(17)(18).…”

Section: Indications For Enteral Nutritionmentioning

confidence: 99%

“…Clinical situations for which EN could be required(11,14,(18)(19)(20) EN ¼ enteral nutrition; UGI ¼ upper gastrointestinal.…”

mentioning

confidence: 99%

Practical Approach to Paediatric Enteral Nutrition: A Comment by the ESPGHAN Committee on Nutrition

Braegger

Décsi

Dias

et al. 2010

J. pediatr. gastroenterol. nutr.

249

254

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Enteral nutrition support (ENS) involves both the delivery of nutrients via feeding tubes and the provision of specialised oral nutritional supplements. ENS is indicated in a patient with at least a partially functioning digestive tract when oral intake is inadequate or intake of normal food is inappropriate to meet the patients' needs. The aim of this comment by the Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition is to provide a clinical practice guide to ENS, based on the available evidence and the clinical expertise of the authors. Statements and recommendations are presented, and future research needs highlighted, with a particular emphasis placed on a practical approach to ENS.Among the wide array of enteral formulations, standard polymeric feeds based on cow's-milk protein with fibre and age adapted for energy and nutrient content are suitable for most paediatric patients. Whenever possible, intragastric is preferred to postpyloric delivery of nutrients, and intermittent feeding is preferred to continuous feeding because it is more physiological. An anticipated duration of enteral nutrition (EN) exceeding 4 to 6 weeks is an indication for gastrostomy or enterostomy. Among the various gastrostomy techniques available, percutaneous endoscopic gastrostomy is currently the first option. In general, both patients and caregivers express satisfaction with this procedure, although it is associated with a number of well-recognised complications. We strongly recommend the development and application of procedural protocols that include scrupulous attention to hygiene, as well as regular monitoring by a multidisciplinary nutrition support team to minimise the risk of EN-associated complications.

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“…Current nutritional recommendations for critically ill children are based on little evidence, as highlighted by the Cochrane Collaboration [3]. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)…”

Section: Introductionmentioning

confidence: 99%