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Nutritional interventions and outcomes after severe traumatic brain injury in children: A systematic review and
Marina Santschi1, Karthik Kumar Balasubramanian1, Jessie Cunningham2
1Department for Pediatric Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Nutritional interventions in children with severe traumatic brain injury (sTBI) show varied impacts on outcomes. Early nutrition may improve neurologic outcomes, while delayed nutrition is linked to increased mortality risk.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Metabolic disorders
Background:
- Severe traumatic brain injury (sTBI) in children disrupts metabolism, affecting energy expenditure, catabolism, and lipolysis.
- These metabolic changes can impede recovery in pediatric patients.
Purpose of the Study:
- To investigate the relationship between nutritional interventions and patient outcomes in children with sTBI.
- To synthesize current evidence on the efficacy of different nutritional strategies.
Main Methods:
- Systematic literature search of multiple databases (MEDLINE, Embase, etc.) up to March 2025.
- Inclusion of retrospective cohort studies involving children (>1 month) with sTBI receiving nutritional interventions.
- Assessment of neurologic/functional outcomes, mortality, length of stay, and nutrition-related measures; meta-analyses performed where feasible.
Main Results:
- Five retrospective cohort studies were included; risk of bias was significant.
- One study found a significant association between early nutritional intervention and improved neurologic outcomes.
- Delayed enteral nutrition (>48h) showed an odds ratio (OR) for mortality of 2.50; unmet caloric intake had an OR of 0.94.
Conclusions:
- Nutrition strategies for pediatric sTBI must be individualized to patient needs.
- Continuous monitoring of nutritional status is crucial for effective and appropriate interventions.
- Further high-quality research is needed due to existing uncertainty and practice variability.
Background And Aims:
Children suffering from severe traumatic brain injury (sTBI) often experience disrupted metabolism, leading to variations in energy expenditure, catabolism, and lipolysis that can negatively impact recovery. We aimed to describe the relationship between nutritional interventions and outcomes after severe traumatic brain injury (sTBI) in children.
Methods:
A systematic search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was conducted up to March 2025. Studies included children older than one month with sTBI and assessed nutritional interventions. Three reviewers screened titles and abstracts, and two performed full-text assessments and data extraction. Risk of bias was evaluated using the ROBINS-I tool. Primary outcome was neurologic or functional outcome. Secondary outcomes included mortality, length of stay, and nutrition-related measures. When possible, meta-analyses were performed using a random effects model.
Results:
From 3530 studies identified, 54 underwent full-text review and 5 retrospective cohort studies were included. Primary outcome was reported in three studies, with one reporting a significant association between timing of nutritional intervention and neurologic outcome and two not demonstrating an association. Delayed enteral nutrition (>48 h) was associated with a combined OR for mortality of 2.50 (0.87-7.20, I2 = 0 %). Unmet caloric intake yielded an OR for mortality of 0.94 (0.18-4.95, I2 = 0 %). Study risk of bias was significant.
Conclusions:
Given the existing uncertainty and variability in practice, it is essential that nutrition strategies for children with sTBI be tailored to each patient's physiological needs. Continuous monitoring of the patient's nutritional status should be prioritized to ensure that interventions remain appropriate and effective throughout the course of treatment.
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