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Optimal nutrition in the paediatric ICU
Koen Joosten1, Esther van Puffelen, Sascha Verbruggen
1ErasmusMC-Sophia Children's Hospital, Department of Paediatric Intensive Care, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
Insights
Optimal nutrition in pediatric intensive care is crucial for improving outcomes. Current strategies lack robust evidence from randomized trials, highlighting the need for more research on feeding regimens for critically ill children.
Area of Science:
- Pediatric intensive care
- Clinical nutrition
- Critical illness
Background:
- Undernutrition increases morbidity and mortality in critically ill children.
- Obesity is linked to complications and poorer outcomes in specific pediatric populations, like burn injuries.
- The relationship between nutritional status and organ function (beyond skin healing) is understudied.
Purpose of the Study:
- To review the best available evidence on optimal nutrition in pediatric intensive care.
- To examine nutritional strategies based on surrogate and hard clinical outcome parameters.
- To identify gaps in current knowledge regarding pediatric critical care nutrition.
Main Methods:
- Literature review of current evidence on pediatric intensive care nutrition.
- Analysis of studies linking nutritional status to clinical outcomes.
- Assessment of data on enteral nutrition delivery and protein intake.
Main Results:
- Evidence suggests a link between adequate enteral nutrition and protein delivery with improved hospital stay, neurological status, and mortality.
- Data on long-term follow-up and health economics related to pediatric critical care nutrition are scarce.
- Current nutritional strategies rely on limited trials with surrogate outcomes, lacking causal evidence.
Conclusions:
- No randomized controlled trials have established causal links between feeding regimens and outcomes in critically ill children.
- Optimal nutritional strategies are currently based on limited evidence and surrogate markers.
- Prospective randomized studies are essential to determine optimal feeding strategies for critically ill children.
Purpose Of Review:
This article describes the current best available evidence on optimal nutrition in the paediatric intensive care based on different levels of outcome, which can be divided in surrogate and hard clinical outcome parameters.
Recent Findings:
Undernutrition is associated with increased morbidity and mortality, whereas in specific cohorts of critically ill children, such as those with burn injury, obesity is associated with more complications, longer length of stay, and decreased likelihood of survival. There is a relation with adequacy of delivery of enteral nutrition and the amount of protein on length of hospital stay, neurological status, and mortality. Studies relating organ function, other than skin healing after thermal injury, with the nutritional status are scarce. There is also a scarcity of data concerning long-term follow-up and health economics.
Summary:
Until now, there are no randomized controlled trials which have investigated a causal relation between different feeding regimens on the nutritional status and short and long-term outcome. As a result current optimal nutritional strategies are based on small trials with surrogate outcome parameters. Prospective randomized studies are needed with nutritional and/or metabolic interventions to come to an optimal feeding strategy for critically ill children.
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