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Temporal nutritional and inflammatory changes in children with severe head injury fed a regular or an
George Briassoulis1, Olga Filippou, Maria Kanariou
1Pediatric Intensive Care Unit, University Hospital of Heraklion, Crete, Greece.
Insights
An immune-enhancing (IE) diet in children with severe head injury may lower interleukin-8 and reduce gastric colonization. However, it did not show additional benefits compared to regular early enteral nutrition.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Immunology
Background:
- Severe head injury in children can lead to significant metabolic and inflammatory responses.
- Early enteral nutrition is crucial for managing critically ill pediatric patients.
- The role of specialized immune-enhancing (IE) diets in this population requires further investigation.
Purpose of the Study:
- To evaluate the impact of an immune-enhancing (IE) diet versus a regular formula on infection and metabolic markers in mechanically ventilated children with severe head injury.
Main Methods:
- A randomized, blinded, controlled study was conducted in a pediatric intensive care unit.
- Forty mechanically ventilated children with severe head injury were randomized to receive either an IE or a regular formula.
- Nutritional intake was advanced over five days to meet predicted basal metabolic rate.
Main Results:
- The IE diet group showed lower interleukin-8 levels and a higher incidence of positive nitrogen balance by day 5.
- Gastric cultures were less frequently positive in the IE group compared to the regular formula group.
- No significant differences were observed in nosocomial infections, length of stay, mechanical ventilation duration, or survival rates between the groups.
Conclusions:
- While an immune-enhancing diet may reduce interleukin-8 and gastric colonization in pediatric severe head injury, it did not demonstrate superior outcomes compared to standard early enteral nutrition.
- Further research is needed to fully elucidate the benefits of immunonutrition in this patient population.
Objective:
To analyze the effect of an immune enhancing (IE) diet on infection and metabolic indices in children with severe head injury fed either an IE or a regular formula.
Design:
: Randomized, blinded, controlled study.
Setting:
Pediatric intensive care unit in a university hospital.
Patients:
A total of 40 mechanically ventilated children with severe head injury.
Interventions:
Within 12 hrs of pediatric intensive care unit admission, patients were randomized to receive a masked formula: either IE or regular formula. Feedings were advanced to a target volume of energy intake equal to 0.50%, 100%, 125%, 150%, and 150% of the predicted basal metabolic rate on days 1-5.
Measurements And Main Results:
Nutritional and metabolic indices; interleukins-1beta, -6, and -8; tumor necrosis factor-alpha; and outcome end points (survival, length of stay, length of mechanical ventilation) were compared between the two groups. Only interleukin-8 levels were lower in the IE group compared with the regular formula group by day 5 (23.6 +/- 1.5 vs. 35.5 +/- 4 pg/mL, p < .04). In multivariate regression analysis, interleukin-8 was also independently negatively correlated with immunonutrition (p < .04). Nitrogen balance became positive in 30.8% of patients in the regular formula group and in 69.2% of patients in the IE group by day 5 (p < .05). Less gastric cultures were positive in the IE group compared with the regular formula group (26.7% vs. 71.4%, p < .02). Nosocomial infections (15% vs. 25%), length of stay (16.7 vs. 12.2 days), length of mechanical ventilation (11 vs. 8 days), and survival (80% vs. 95%) did not differ between groups.
Conclusions:
Although immunonutrition might decrease interleukin-8 and gastric colonization in children with severe head injury, it might not be associated with additional advantage over the one demonstrated by regular early enteral nutrition.
