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Optimal Enteral Nutrition Support Preserved Muscle Mass in Critically Ill Children
Kantisa Sirianansopa1, Chavisa Rassameehirun1, Sirinuch Chomtho2,3
1Division of Pulmonology and Critical Care, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Optimal enteral nutrition support effectively preserves muscle mass in critically ill children. This guideline-based approach minimizes protein breakdown and supports recovery in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Metabolic research
Background:
- Inflammation and immobility are key factors driving protein breakdown in critically ill children.
- Increased protein catabolism is linked to higher morbidity and mortality rates in this vulnerable population.
- Understanding these mechanisms is crucial for developing effective therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy of a standard enteral nutrition support guideline in preventing muscle wasting in critically ill children.
- To assess the guideline's ability to meet targeted caloric and protein intake goals.
- To determine the impact of this nutritional strategy on muscle mass preservation.
Main Methods:
- A prospective cohort study was conducted in a pediatric intensive care unit (PICU).
- Critically ill children (1 month to 15 years) received enteral nutrition support within 24 hours, adhering to established guidelines.
- Nutritional targets were individualized, and body composition was assessed using bioelectrical impedance analysis (BIA) at baseline and day 7.
Main Results:
- Sixty-three pediatric patients were enrolled; respiratory issues were the most common admission diagnosis.
- Despite high rates of mechanical ventilation and initial undernutrition, 95.2% received enteral feeding.
- Muscle mass was significantly preserved after the first week (p < 0.01), with all patients achieving target intake goals.
Conclusions:
- Implementing a structured enteral nutrition support guideline is effective in minimizing protein catabolism in critically ill children.
- This evidence-based nutrition practice enables pediatric patients to achieve essential caloric and protein targets, aiding in muscle mass preservation.
- The guideline demonstrates a low complication rate (1.6%), highlighting its safety and efficacy.
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.
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