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Chinese guidelines for the assessment and provision of nutrition support therapy in critically ill children
Xue-Mei Zhu1, Su-Yun Qian2, Guo-Ping Lu1
1Children's Hospital, Fudan University, No. 399 Wanyuan Road, Minhang District, 201100, Shanghai, China.
Insights
These guidelines offer evidence-based nutrition therapy for critically ill children. Key recommendations include early enteral nutrition and specific protein intake, emphasizing individualized care for better outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Nutrition
- Evidence-Based Guidelines
Background:
- First evidence-based guidelines for nutrition therapy in critically ill children (1 month to 18 years).
- Focuses on patients with expected intensive care unit stays exceeding 2-3 days.
Purpose of the Study:
- To establish best practices in nutrition therapy for critically ill pediatric patients.
- To provide evidence-based recommendations for nutritional support in this vulnerable population.
Main Methods:
- Systematic review of 25,673 articles, with 88 studies included in the guidelines.
- Utilized the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria to assess evidence quality.
Main Results:
- Emphasizes nutritional assessment and detection of malnutrition.
- Recommends indirect calorimetry for energy expenditure; suggests 50 kcal/kg/day if unfeasible.
- Prioritizes early enteral nutrition (EN) with a minimum protein intake of 1.5 g/kg/day.
- Suggests supplemental parenteral nutrition (PN) cautiously for low-risk patients; immune-enhancing formulas not recommended.
Conclusions:
- Pediatric critically ill patients are a heterogeneous group requiring individualized nutrition support.
- Personalized nutrition therapy is crucial for improving clinical outcomes in pediatric intensive care.
Background:
This document represents the first evidence-based guidelines to describe best practices in nutrition therapy in critically ill children (> 1 month and < 18 years), who are expected to require a length of stay more than 2 or 3 days in a Pediatric Intensive Care Unit admitting medical patients domain.
Methods:
A total of 25,673 articles were scanned for relevance. After careful review, 88 studies appeared to answer the pre-identified questions for the guidelines. We used the grading of recommendations, assessment, development and evaluation criteria to adjust the evidence grade based on the quality of design and execution of each study.
Results:
The guidelines emphasise the importance of nutritional assessment, particularly the detection of malnourished patients. Indirect calorimetry (IC) is recommended to estimate energy expenditure and there is a creative value in energy expenditure, 50 kcal/kg/day for children aged 1-8 years during acute phase if IC is unfeasible. Enteral nutrition (EN) and early enteral nutrition remain the preferred routes for nutrient delivery. A minimum protein intake of 1.5 g/kg/day is suggested for this patient population. The role of supplemental parenteral nutrition (PN) has been highlighted in patients with low nutritional risk, and a delayed approach appears to be beneficial in this group of patients. Immune-enhancing cannot be currently recommended neither in EN nor PN.
Conclusion:
Overall, the pediatric critically ill population is heterogeneous, and an individualized nutrition support with the aim of improving clinical outcomes is necessary and important.
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