Early Enteral Nutrition Is Associated With Lower Mortality in Critically Ill Children

Mikhailov, Theresa A.; Kuhn, Evelyn M.; Manzi, Jennifer; Christensen, Melissa; Collins, Maureen M.; Brown, Ann‐Marie; Dechert, Ronald E.; Scanlon, Matthew C.; Wakeham, Martin K.; Goday, Praveen S.

doi:10.1177/0148607113517903

Cited by 149 publications

(176 citation statements)

References 40 publications

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“…The timing and impact of supplementary PN in critically ill children are currently being investigated. Over the past decade, EN has been the preferred mode of nutrient delivery (3,6,8,20). EN was initiated by the third day in the PICU in 80% of our cohort.…”

Section: Discussionmentioning

confidence: 97%

“…Early EN delivery has been recommended in patients who are hemodynamically stable and have a functioning gastrointestinal tract (11). Early EN may be associated with favorable metabolic and endocrine profiles and even with lower mortality in critically ill children (3,21). In children with a burn injury, early EN has been associated with reductions in mortality, hospital length of stay, infectious complications, caloric deficits, weight loss, protein breakdown, and altered small-bowel mucosal permeability (21,22).…”

Section: Discussionmentioning

confidence: 99%

“…The achievement of nutrient intake goals during critical illness has been associated with increased 60-d mortality, acquired infections, length of stay, and nutritional morbidity (1,2). Enteral nutrition (EN) is the preferred mode of nutrient delivery in critically ill children with a functional gastrointestinal tract and is often initiated early to facilitate the achievement of the daily goal (3,4). However, a variety of factors impede nutrient delivery in the PICU, including multiple interruptions to EN and a lack of a uniform feeding approach at the bedside (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study

Mehta

Bechard

Zurakowski

et al. 2015

The American Journal of Clinical Nutrition

190

153

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Background: The impact of protein intake on outcomes in pediatric critical illness is unclear. Objective: We examined the association between protein intake and 60-d mortality in mechanically ventilated children. Design: In a prospective, multicenter, cohort study that included 59 pediatric intensive care units (PICUs) from 15 countries, we enrolled consecutive children (age: 1 mo to 18 y) who were mechanically ventilated for $48 h. We recorded the daily and cumulative mean adequacies of energy and protein delivery as a percentage of the prescribed daily goal during the PICU stay #10 d. We examined the association of the adequacy of protein delivery with 60-d mortality and determined variables that predicted protein intake adequacy. Results: We enrolled 1245 subjects (44% female) with a median age of 1.7 y (IQR: 0.4, 7.0 y). A total of 985 subjects received enteral nutrition, 354 (36%) of whom received enteral nutrition via the postpyloric route. Mean 6 SD prescribed energy and protein goals were 69 6 28 kcal/kg per day and 1.9 6 0.7 g/kg per day, respectively. The mean delivery of enteral energy and protein was 36 6 35% and 37 6 38%, respectively, of the prescribed goal. The adequacy of enteral protein intake was significantly associated with 60-d mortality (P , 0.001) after adjustment for disease severity, site, PICU days, and energy intake. In relation to mean enteral protein intake ,20%, intake $60% of the prescribed goal was associated with an OR of 0.14 (95% CI: 0.04, 0.52; P = 0.003) for 60-d mortality. Early initiation, postpyloric route, shorter interruptions, larger PICU size, and a dedicated dietitian in the PICU were associated with higher enteral protein delivery. Conclusions: Delivery of .60% of the prescribed protein intake is associated with lower odds of mortality in mechanically ventilated children. Optimal prescription and modifiable practices at the bedside might enhance enteral protein delivery in the PICU with a potential for improved outcomes. This trial was registered at clinicaltrials.gov as NCT02354521.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study

Mehta

Bechard

Zurakowski

et al. 2015

The American Journal of Clinical Nutrition

190

153

View full text Add to dashboard Cite

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“…The most recent guidelines recommended the initiation of enteral nutrition as early as possible, i.e., within 24 h after PICU admission, and the supply of at least 25% of energy requirements within 48 h [60,66].…”

Section: Enteral Nutritionmentioning

confidence: 99%

Zasady leczenia żywieniowego na oddziałach intensywnej terapii dziecięcej. Wspólne stanowisko towarzystw naukowych: Sekcji Anestezji i Intensywnej Terapii Dziecięcej PTAiIT, PTN, PTŻKD

Bartkowska-Śniatkowska¹,

Zielińska²,

Świder³

et al. 2015

Anaesthesiol Intensive Ther

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Providing nutritional therapy via the gastrointestinal tract in patients in paediatric intensive care units (PICUs) is an effective method for delivering energy and other nutrients. In the event of contraindications to using this method, it is necessary to commence parenteral nutrition. In the present study, methods for nutritional treatments in critically ill children are presented, depending on the clinical situation.

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“…Despite the ongoing debate on the impact of early nutritional support on clinical outcomes, such as reduction of mortality, invasive ventilation and length of hospital stay [8-10], in current practice every effort is given to initiate early feeding and to improve the delivery of nutritional requirements using enteral nutrition (EN), limiting whenever possible use of the parenteral route. The effectiveness of the nutritional adequacy of exclusive EN remains unclear and may vary according to the presence or not, of multidisciplinary management and dietetic support.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care

et al. 2014

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BackgroundProvision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children.MethodsData on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored.ResultsData were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p ≤ 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p ≤ 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p < 0.05) and a greater proportion of these delivered as EN (p < 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met.ConclusionsProvision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other “non-nutritional” fluids whenever this is possible.

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Early Enteral Nutrition Is Associated With Lower Mortality in Critically Ill Children

Abstract: EEN is strongly associated with lower mortality in patients with PICU LOS of ≥96 hours. LOS and duration of MV are slightly longer in patients receiving EEN, but the differences are not statistically significant.

Cited by 149 publications

References 40 publications

Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study

Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study

Zasady leczenia żywieniowego na oddziałach intensywnej terapii dziecięcej. Wspólne stanowisko towarzystw naukowych: Sekcji Anestezji i Intensywnej Terapii Dziecięcej PTAiIT, PTN, PTŻKD

An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care

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