Optimal Enteral Nutrition Support Preserved Muscle Mass in Critically Ill Children

Abstract

Background. Inflammation and immobility are the most relevant mechanisms that alter protein synthesis and increase protein breakdown. Protein catabolism is associated with morbidity and mortality in critically ill children. Objective. To demonstrate the effectiveness of the routinely used enteral nutrition support guideline in preventing muscle breakdown in critically ill children. Methods. A prospective cohort study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital. Critically ill children (aged 1 month to 15 years) admitted to the PICU were enrolled. All patients were assessed for nutritional status and nutritional requirement. Enteral nutrition support following the guideline was initiated within the first 24 hours if no contraindication. The calorie target was defined either by direct measurement from indirect calorimetry or estimated from Schofield equation with protein target at least 1.5 g/kg/day. Anthropometric assessments and body composition measurements by bioelectrical impedance analysis (BIA) were examined at baseline and on the seventh day of the PICU admission. Results. Sixty-three patients were enrolled in the study. The most common age group was 1–5 years old (38.1%). The length of PICU stay was 9.1 (SD = 12.7) days. Respiratory problems were the major cause of PICU admission (50.8%). Mechanical ventilation was required in 55.6% of the patients with the average duration of 6.3 (SD = 12.4) days. Undernutrition was found in 36.5% of the patients. Enteral feeding was the major route of nutrition support (95.2%). After the first week of admission, muscle mass was significantly preserved ( p < 0.01 ). All patients received the nutrition support at their target energy and protein goal within the first week. The enteral feeding-related complication was reported in 1.6% of the patients. Conclusion. Protein catabolism during critically ill period can be minimized by optimal nutrition support. Nutrition practice using the enteral nutrition support guideline was effective in helping critically ill children reach their target caloric and protein intake.

Modified ABCDEF-Bundles for Critically Ill Pediatric Patients - What Could They Look Like?

“…Without question, physiological nutrition, and healthy sleep patterns are fundamental needs for children recuperating from severe illness and to prevent further deterioration ( 90 ). For a newly developed bundle G we therefore propose to include, again, standardized protocols for daily reevaluation of nutritional needs, determining severity of illness, weighing parenteral against early enteral nutrition, defining caloric needs and identifying patients in need of rehabilitational specialists for assessment and treatment of feeding and swallowing difficulties ( 91 , 92 ). Next to “Good nutrition” we include “good sleep” and promote early support of a circadian rhythm, moving any possible intervention and diagnostics aside from emergencies into daylight hours and providing a calm and dark environment for uninterrupted sleep during nighttime for all children, irrelevant of their depth of sedation ( 25 ).…”

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

“…Specifically, late initiation of EN is associated with prolonged hospitalization days, LOS in the PICU, and days in mechanical ventilation (DMV) [ 38 ]. Furthermore, nutrition support is not only related to the amelioration of clinical-related outcomes such as LOS and DMV but also to the preservation of the patient’s muscle mass by minimizing protein catabolism [ 39 ].…”