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Peptide-based versus standard polymeric enteral nutrition in the PICU: a multicenter observational study
Merve Misirlioglu Celik1, Dincer Yildizdas2, Faruk Ekinci2
1Department of Pediatric Intensive Care Unit, Mersin University Faculty of Medicine, Mersin, Türkiye.
Insights
Peptide-based formulas (PBF) in pediatric intensive care units (PICUs) were associated with lower infection rates and constipation compared to standard polymeric formulas (SPF). While SPF provided earlier caloric intake, outcomes were similar by day 7, suggesting individualized formula selection.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Gastroenterology
Background:
- Standard polymeric formulas (SPF) are recommended for enteral nutrition in critically ill children.
- Peptide-based formulas (PBF) are increasingly used to enhance enteral nutrition and mitigate complications.
- This study compares clinical outcomes of PBF versus SPF in pediatric intensive care units (PICUs).
Purpose of the Study:
- To evaluate the clinical outcomes of peptide-based formulas (PBF) compared to standard polymeric formulas (SPF) in critically ill pediatric patients.
- To determine the impact of formula type on key clinical outcomes, including infection rates and nutritional intake.
- To inform evidence-based decisions regarding enteral nutrition strategies in PICUs.
Main Methods:
- A multicenter, prospective study involving pediatric patients receiving enteral nutrition in PICUs.
- Comparison of patients receiving PBFs versus SPFs, utilizing propensity score matching and inverse probability of treatment weighting (IPTW) for adjustment.
- Inclusion of 574 patients with analysis of baseline characteristics, caloric intake, and complication rates.
Main Results:
- After IPTW adjustment, baseline characteristics were balanced. Early caloric intake by day 2 was higher with SPF (p < 0.001), but no difference was seen by day 7 (p = 0.853).
- Nosocomial infections were significantly lower with PBF (17.6%) compared to SPF (23.5%) [OR = 0.7 (95% CI, 0.5-0.9); p = 0.015].
- Constipation was more frequent with SPF (p = 0.010), and greater protein reduction was observed with SPF on day 2 (p < 0.001).
Conclusions:
- While SPF facilitated earlier caloric and protein intake, overall outcomes were comparable by day 7.
- PBF use was linked to reduced infection rates and less need for mechanical ventilation.
- Individualized selection of enteral formulas is recommended, warranting further research to clarify optimal strategies.
Background:
Nutritional guidelines recommend initiating enteral nutrition with standard polymeric formula (SPF) in critically ill children. Peptide-based formulas (PBF) have been increasingly used to improve enteral nutrition and reduce related complications. This study evaluated the clinical outcomes associated with PBF use compared with SPF in the PICU setting.
Methods:
This multicenter, prospective study included pediatric patients admitted to PICUs who received enteral nutrition. Patients receiving PBFs were compared with those receiving SPFs. To reduce baseline imbalances and potential confounding, propensity score matching with inverse probability of treatment weighting (IPTW) was applied.
Results:
A total of 574 patients were included. After IPTW adjustment, baseline characteristics were well balanced between groups. The rate of achieving target caloric intake by day 2 was significantly higher in the SPF group (p < 0.001); whereas no significant difference was observed by day 7 (mean difference = 0.7, p = 0.853). After adjustment, the incidence of nosocomial infections was significantly higher in the SPF group compared with the PBF group [23.5 vs. 17.6%; OR = 0.7 (95% CI, 0.5-0.9); p = 0.015]. Significantly greater reduction in proteins consumed on day 2 was observed in favor of the SPF group (mean difference -0.3, p < 0.001). Constipation was significantly more common in the SPF group (p = 0.010).
Conclusions:
Although early caloric and protein intake was higher in patients receiving standard polymeric formulas, outcomes were comparable by day 7. Lower infection rates and reduced need for mechanical ventilation were observed in patients receiving peptide-based formulas. Enteral formula selection should be individualized, and further studies are needed to clarify this subject.
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