Nutrition in Pediatric Intensive Care: A Narrative Review

Milan Kratochvíl, Jozef Klučka, Eva Klabusayová, Tereza Musilová, Václav Vafek, Tamara Skříšovská, Jana Djakow, Pavla Havránková, Denisa Osinová, Petr Štourač, Milan Kratochvíl, Jozef Klučka, Eva Klabusayová, Tereza Musilová, Václav Vafek, Tamara Skříšovská, Jana Djakow, Pavla Havránková, Denisa Osinová, Petr Štourač

Abstract

Nutrition support in pediatric intensive care is an integral part of a complex approach to treating critically ill children. Smaller energy reserves with higher metabolic demands (a higher basal metabolism rate) compared to adults makes children more vulnerable to starvation. The nutrition supportive therapy should be initiated immediately after intensive care admission and initial vital sign stabilization. In absence of contraindications (unresolving/decompensated shock, gut ischemia, critical gut stenosis, etc.), the preferred type of enteral nutrition is oral or via a gastric tube. In the acute phase of critical illness, due to gluconeogenesis and muscle breakdown with proteolysis, the need for high protein delivery should be emphasized. After patient condition stabilization, the acute phase with predominant catabolism converts to the anabolic phase and intensive rehabilitation, where high energy demands are the keystone of a positive outcome.

Keywords: child; enteral feeding; intensive care; nutrition; nutrition support; parenteral nutrition; pediatric.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Example of a stepwise approach to enteral nutrition.

References

    1. Tume L.N., Valla F.V., Joosten K., Jotterand Chaparro C., Latten L., Marino L.V., Macleod I., Moullet C., Pathan N., Rooze S., et al. Nutritional Support for Children during Critical Illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Metabolism, Endocrine and Nutrition Section Position Statement and Clinical Recommendations. Intensive Care Med. 2020;46:411–425. doi: 10.1007/s00134-019-05922-5.
    1. Joosten K.F.M., Kerklaan D., Verbruggen S.C.A.T. Nutritional Support and the Role of the Stress Response in Critically Ill Children. Curr. Opin. Clin. Nutr. Metab. Care. 2016;19:226–233. doi: 10.1097/MCO.0000000000000268.
    1. Joosten K.F.M., Eveleens R.D., Verbruggen S.C.A.T. Nutritional Support in the Recovery Phase of Critically Ill Children. Curr. Opin. Clin. Nutr. Metab. Care. 2019;22:152–158. doi: 10.1097/MCO.0000000000000549.
    1. Singer P., Blaser A.R., Berger M.M., Alhazzani W., Calder P.C., Casaer M.P., Hiesmayr M., Mayer K., Montejo J.C., Pichard C., et al. ESPEN Guideline on Clinical Nutrition in the Intensive Care Unit. Clin. Nutr. 2019;38:48–79. doi: 10.1016/j.clnu.2018.08.037.
    1. Van Puffelen E., Hulst J.M., Vanhorebeek I., Dulfer K., Van den Berghe G., Verbruggen S.C.A.T., Joosten K.F.M. Outcomes of Delaying Parenteral Nutrition for 1 Week vs. Initiation Within 24 Hours Among Undernourished Children in Pediatric Intensive Care: A Subanalysis of the PEPaNIC Randomized Clinical Trial. JAMA Netw. Open. 2018;1:e182668. doi: 10.1001/jamanetworkopen.2018.2668.
    1. Prince N.J., Brown K.L., Mebrahtu T.F., Parslow R.C., Peters M.J. Weight-for-Age Distribution and Case-Mix Adjusted Outcomes of 14,307 Paediatric Intensive Care Admissions. Intensive Care Med. 2014;40:1132–1139. doi: 10.1007/s00134-014-3381-x.
    1. Van Puffelen E., Hulst J.M., Vanhorebeek I., Dulfer K., Van den Berghe G., Joosten K.F.M., Verbruggen S.C.A.T. Effect of Late versus Early Initiation of Parenteral Nutrition on Weight Deterioration during PICU Stay: Secondary Analysis of the PEPaNIC Randomised Controlled Trial. Clin. Nutr. 2020;39:104–109. doi: 10.1016/j.clnu.2019.02.014.
    1. Mihatsch W., Fewtrell M., Goulet O., Molgaard C., Picaud J.-C., Senterre T., Braegger C., Bronsky J., Cai W., Campoy C., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Calcium, Phosphorus and Magnesium. Clin. Nutr. 2018;37:2360–2365. doi: 10.1016/j.clnu.2018.06.950.
    1. McClave S.A., Taylor B.E., Martindale R.G., Warren M.M., Johnson D.R., Braunschweig C., McCarthy M.S., Davanos E., Rice T.W., Cresci G.A., et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) J. Parenter. Enter. Nutr. 2016;40:159–211. doi: 10.1177/0148607115621863.
    1. Bechard L.J., Duggan C., Touger-Decker R., Parrott J.S., Rothpletz-Puglia P., Byham-Gray L., Heyland D., Mehta N.M. Nutritional Status Based on Body Mass Index Is Associated with Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU. Crit. Care Med. 2016;44:1530–1537. doi: 10.1097/CCM.0000000000001713.
    1. Mehta N.M., Bechard L.J., Cahill N., Wang M., Day A., Duggan C.P., Heyland D.K. Nutritional Practices and Their Relationship to Clinical Outcomes in Critically Ill Children—An International Multicenter Cohort Study. Crit. Care Med. 2012;40:2204–2211. doi: 10.1097/CCM.0b013e31824e18a8.
    1. Mehta N.M., Bechard L.J., Zurakowski D., Duggan C.P., Heyland D.K. Adequate Enteral Protein Intake Is Inversely Associated with 60-d Mortality in Critically Ill Children: A Multicenter, Prospective, Cohort Study. Am. J. Clin. Nutr. 2015;102:199–206. doi: 10.3945/ajcn.114.104893.
    1. Ross P.A., Newth C.J.L., Leung D., Wetzel R.C., Khemani R.G. Obesity and Mortality Risk in Critically Ill Children. Pediatrics. 2016;137:e20152035. doi: 10.1542/peds.2015-2035.
    1. de Souza Menezes F., Leite H.P., Koch Nogueira P.C. Malnutrition as an Independent Predictor of Clinical Outcome in Critically Ill Children. Nutr. Burbank. 2012;28:267–270. doi: 10.1016/j.nut.2011.05.015.
    1. Delgado A.F., Okay T.S., Leone C., Nichols B., Del Negro G.M., Vaz F.A.C. Hospital Malnutrition and Inflammatory Response in Critically Ill Children and Adolescents Admitted to a Tertiary Intensive Care Unit. Clinics. 2008;63:357–362. doi: 10.1590/S1807-59322008000300012.
    1. Briassoulis G., Zavras N., Hatzis T. Malnutrition, Nutritional Indices, and Early Enteral Feeding in Critically Ill Children. Nutrition. 2001;17:548–557. doi: 10.1016/S0899-9007(01)00578-0.
    1. Hulst J., Joosten K., Zimmermann L., Hop W., van Buuren S., Büller H., Tibboel D., van Goudoever J. Malnutrition in Critically Ill Children: From Admission to 6 Months after Discharge. Clin. Nutr. 2004;23:223–232. doi: 10.1016/S0261-5614(03)00130-4.
    1. Mehta N.M., Skillman H.E., Irving S.Y., Coss-Bu J.A., Vermilyea S., Farrington E.A., McKeever L., Hall A.M., Goday P.S., Braunschweig C. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatr. Crit. Care Med. 2017;18:675–715. doi: 10.1097/PCC.0000000000001134.
    1. Heyland D.K., Dhaliwal R., Jiang X., Day A.G. Identifying Critically Ill Patients Who Benefit the Most from Nutrition Therapy: The Development and Initial Validation of a Novel Risk Assessment Tool. Crit. Care. 2011;15:R268. doi: 10.1186/cc10546.
    1. Kondrup J., Rasmussen H.H., Hamberg O., Stanga Z., Ad Hoc ESPEN Working Group Nutritional Risk Screening (NRS 2002): A New Method Based on an Analysis of Controlled Clinical Trials. Clin. Nutr. 2003;22:321–336. doi: 10.1016/S0261-5614(02)00214-5.
    1. Sermet-Gaudelus I., Poisson-Salomon A.S., Colomb V., Brusset M.C., Mosser F., Berrier F., Ricour C. Simple Pediatric Nutritional Risk Score to Identify Children at Risk of Malnutrition. Am. J. Clin. Nutr. 2000;72:64–70. doi: 10.1093/ajcn/72.1.64.
    1. Gerasimidis K., Macleod I., Maclean A., Buchanan E., McGrogan P., Swinbank I., McAuley M., Wright C.M., Flynn D.M. Performance of the Novel Paediatric Yorkhill Malnutrition Score (PYMS) in Hospital Practice. Clin. Nutr. 2011;30:430–435. doi: 10.1016/j.clnu.2011.01.015.
    1. McCarthy H., Dixon M., Crabtree I., Eaton-Evans M.J., McNulty H. The Development and Evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for Use by Healthcare Staff. J. Hum. Nutr. Diet. Off. J. Br. Diet. Assoc. 2012;25:311–318. doi: 10.1111/j.1365-277X.2012.01234.x.
    1. White M., Lawson K., Ramsey R., Dennis N., Hutchinson Z., Soh X.Y., Matsuyama M., Doolan A., Todd A., Elliott A., et al. Simple Nutrition Screening Tool for Pediatric Inpatients. JPEN J. Parenter. Enteral Nutr. 2016;40:392–398. doi: 10.1177/0148607114544321.
    1. Chourdakis M., Hecht C., Gerasimidis K., Joosten K.F., Karagiozoglou-Lampoudi T., Koetse H.A., Ksiazyk J., Lazea C., Shamir R., Szajewska H., et al. Malnutrition Risk in Hospitalized Children: Use of 3 Screening Tools in a Large European Population. Am. J. Clin. Nutr. 2016;103:1301–1310. doi: 10.3945/ajcn.115.110700.
    1. Wischmeyer P.E., San-Millan I. Winning the War against ICU-Acquired Weakness: New Innovations in Nutrition and Exercise Physiology. Crit. Care. 2015;19((Suppl. 3)):S6. doi: 10.1186/cc14724.
    1. Looijaard W.G.P.M., Dekker I.M., Stapel S.N., Girbes A.R.J., Twisk J.W.R., Oudemans-van Straaten H.M., Weijs P.J.M. Skeletal Muscle Quality as Assessed by CT-Derived Skeletal Muscle Density Is Associated with 6-Month Mortality in Mechanically Ventilated Critically Ill Patients. Crit. Care. 2016;20:386. doi: 10.1186/s13054-016-1563-3.
    1. Thibault R., Makhlouf A.-M., Mulliez A., Cristina Gonzalez M., Kekstas G., Kozjek N.R., Preiser J.-C., Rozalen I.C., Dadet S., Krznaric Z., et al. Fat-Free Mass at Admission Predicts 28-Day Mortality in Intensive Care Unit Patients: The International Prospective Observational Study Phase Angle Project. Intensive Care Med. 2016;42:1445–1453. doi: 10.1007/s00134-016-4468-3.
    1. Reintam Blaser A., Starkopf J., Alhazzani W., Berger M.M., Casaer M.P., Deane A.M., Fruhwald S., Hiesmayr M., Ichai C., Jakob S.M., et al. Early Enteral Nutrition in Critically Ill Patients: ESICM Clinical Practice Guidelines. Intensive Care Med. 2017;43:380–398. doi: 10.1007/s00134-016-4665-0.
    1. Kreymann K.G., Berger M.M., Deutz N.E.P., Hiesmayr M., Jolliet P., Kazandjiev G., Nitenberg G., van den Berghe G., Wernerman J., DGEM (German Society for Nutritional Medicine) et al. ESPEN Guidelines on Enteral Nutrition: Intensive Care. Clin. Nutr. 2006;25:210–223. doi: 10.1016/j.clnu.2006.01.021.
    1. Singer P., Berger M.M., Van den Berghe G., Biolo G., Calder P., Forbes A., Griffiths R., Kreyman G., Leverve X., Pichard C., et al. ESPEN Guidelines on Parenteral Nutrition: Intensive Care. Clin. Nutr. 2009;28:387–400. doi: 10.1016/j.clnu.2009.04.024.
    1. Kerklaan D., Augustus M.E., Hulst J.M., van Rosmalen J., Verbruggen S.C.A.T., Joosten K.F.M. Validation of Ventilator-Derived VCO2 Measurements to Determine Energy Expenditure in Ventilated Critically Ill Children. Clin. Nutr. 2017;36:452–457. doi: 10.1016/j.clnu.2016.01.001.
    1. van Goudoever J.B., Carnielli V., Darmaun D., Sainz de Pipaon M., Braegger C., Bronsky J., Cai W., Campoy C., Carnielli V., Darmaun D., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Amino Acids. Clin. Nutr. 2018;37:2315–2323. doi: 10.1016/j.clnu.2018.06.945.
    1. Fivez T., Kerklaan D., Mesotten D., Verbruggen S., Wouters P.J., Vanhorebeek I., Debaveye Y., Vlasselaers D., Desmet L., Casaer M.P., et al. Early versus Late Parenteral Nutrition in Critically Ill Children. N. Engl. J. Med. 2016;374:1111–1122. doi: 10.1056/NEJMoa1514762.
    1. van Puffelen E., Vanhorebeek I., Joosten K.F.M., Wouters P.J., Van den Berghe G., Verbruggen S.C.A.T. Early versus Late Parenteral Nutrition in Critically Ill, Term Neonates: A Preplanned Secondary Subgroup Analysis of the PEPaNIC Multicentre, Randomised Controlled Trial. Lancet Child Adolesc. Health. 2018;2:505–515. doi: 10.1016/S2352-4642(18)30131-7.
    1. Mesotten D., Joosten K., van Kempen A., Verbruggen S., Braegger C., Bronsky J., Cai W., Campoy C., Carnielli V., Darmaun D., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Carbohydrates. Clin. Nutr. 2018;37:2337–2343. doi: 10.1016/j.clnu.2018.06.947.
    1. NICE-SUGAR Study Investigators. Finfer S., Chittock D.R., Su S.Y.-S., Blair D., Foster D., Dhingra V., Bellomo R., Cook D., Dodek P., et al. Intensive versus Conventional Glucose Control in Critically Ill Patients. N. Engl. J. Med. 2009;360:1283–1297. doi: 10.1056/NEJMoa0810625.
    1. Lapillonne A., Fidler Mis N., Goulet O., van den Akker C.H.P., Wu J., Koletzko B., Braegger C., Bronsky J., Cai W., Campoy C., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Lipids. Clin. Nutr. 2018;37:2324–2336. doi: 10.1016/j.clnu.2018.06.946.
    1. Jochum F., Moltu S.J., Senterre T., Nomayo A., Goulet O., Iacobelli S., Braegger C., Bronsky J., Cai W., Campoy C., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Fluid and Electrolytes. Clin. Nutr. 2018;37:2344–2353. doi: 10.1016/j.clnu.2018.06.948.
    1. Chesney C.R. The Maintenance Need for Water in Parenteral Fluid Therapy, by Malcolm A. Holliday, MD, and William E. Segar, MD, Pediatrics, 1957;19:823-832. Pediatrics. 1998;102:229–230.
    1. Mahmoodpoor A., Shadvar K., Sanaie S., Hadipoor M.R., Pourmoghaddam M.A., Saghaleini S.H. Effect of Vitamin C on Mortality of Critically Ill Patients with Severe Pneumonia in Intensive Care Unit: A Preliminary Study. BMC Infect. Dis. 2021;21:616. doi: 10.1186/s12879-021-06288-0.
    1. Fowler A.A., Truwit J.D., Hite R.D., Morris P.E., DeWilde C., Priday A., Fisher B., Thacker L.R., Natarajan R., Brophy D.F., et al. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients with Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA. 2019;322:1261–1270. doi: 10.1001/jama.2019.11825.
    1. Bronsky J., Campoy C., Braegger C., Braegger C., Bronsky J., Cai W., Campoy C., Carnielli V., Darmaun D., Decsi T., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Vitamins. Clin. Nutr. 2018;37:2366–2378. doi: 10.1016/j.clnu.2018.06.951.
    1. Domellöf M., Szitanyi P., Simchowitz V., Franz A., Mimouni F., Braegger C., Bronsky J., Cai W., Campoy C., Carnielli V., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Iron and Trace Minerals. Clin. Nutr. 2018;37:2354–2359. doi: 10.1016/j.clnu.2018.06.949.
    1. Ichimaru S. Methods of Enteral Nutrition Administration in Critically Ill Patients: Continuous, Cyclic, Intermittent, and Bolus Feeding. Nutr. Clin. Pract. 2018;33:790–795. doi: 10.1002/ncp.10105.
    1. Kolaček S., Puntis J.W.L., Hojsak I., Braegger C., Bronsky J., Cai W., Campoy C., Carnielli V., Darmaun D., Decsi T., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Venous Access. Clin. Nutr. 2018;37:2379–2391. doi: 10.1016/j.clnu.2018.06.952.
    1. Riskin A., Picaud J.-C., Shamir R., Braegger C., Bronsky J., Cai W., Campoy C., Carnielli V., Darmaun D., Decsi T., et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Standard versus Individualized Parenteral Nutrition. Clin. Nutr. 2018;37:2409–2417. doi: 10.1016/j.clnu.2018.06.955.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться