Nutrition for critically ill children in paediatric intensive care units

Joffe A, Anton N, Lequier L, Vandermeer B, Tjosvold L, Larsen B, Hartling L

Published Online:

April 15, 2009

There is little evidence to support or refute the need to provide nutrition to critically ill children in a paediatric intensive care unit during the first week of their critical illness.

Giving nutrition in the form of tube feeding (enteral) or intravenous feeding (parenteral) is often considered a priority during critical illness in children. There are reasons to think this may not necessarily be true. During critical illness the body's metabolism is changed and the need for calories is reduced. There are known side effects from giving too much nutrition, such as delays in being able to take the child off a respiratory ventilator, liver problems, and worsened inflammation. We found only one small randomized controlled trial that compared early feeding (within 24 hours of injury) with conventional feeding (after at least 48 hours). The study showed no differences between the groups for any of the outcomes examined. Further research in this area is urgently needed to help guide optimal treatment of children with critical illness.

Abstract (click to read)

Background:

Nutritional support in the critically ill child has not been well investigated and is a controversial topic within paediatric intensive care. There are no clear guidelines as to the best form or timing of nutrition in critically ill infants and children.

Objectives:

To assess the impact of enteral and total parenteral nutrition on clinically important outcomes for critically ill children.

Search strategy:

We searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1); Ovid MEDLINE (1966 to February 2007); Ovid EMBASE (1988 to February 2007); OVID Evidence-Based Medicine Reviews; ISI Web of Science - Science Citation Index Expanded (1965 to February 2007); WebSPIRS Biological Abstracts (1969 to February 2007); and WebSPIRS CAB Abstracts (1972 to February 2007). We also searched trial registries; reviewed reference lists of all potentially relevant studies; handsearched relevant conference proceedings; and contacted experts in the area and manufacturers of enteral and parenteral nutrition products. We did not limit the search by language or publication status.

Selection criteria:

We included studies if they were randomized controlled trials; involved paediatric patients, aged one day to 18 years of age, cared for in a paediatric intensive care unit setting (PICU) and received nutrition within the first seven days of admission; and reported data for at least one of the pre-specified outcomes (30-day or PICU mortality; length of stay in PICU or hospital; number of ventilator days; and morbid complications, such as nosocomial infections). We excluded studies if they only reported nutritional outcomes, quality of life assessments, or economic implications. Furthermore, other areas of paediatric nutrition, such as immunonutrition and different routes of delivering enteral nutrition, were not addressed in this review.

Data collection and analysis:

Two authors independently screened searches, applied inclusion criteria, and performed quality assessments. We resolved discrepancies through discussion and consensus. One author extracted data and a second checked data for accuracy and completeness.

Main results:

Only one trial was identified as relevant. Seventy-seven children in intensive care with burns involving > 25% of the total body surface area were randomized to either enteral nutrition within 24 hours or after at least 48 hours. No statistically significant differences were observed for mortality, sepsis, ventilator days, length of stay, unexpected adverse events, resting energy expenditure, nitrogen balance, or albumin levels. The trial was assessed as of low methodological quality (based on the Jadad scale) with an unclear risk of bias.

Authors' conclusions:

There was only one randomized trial relevant to the review question. Research is urgently needed to identify best practices regarding the timing and forms of nutrition for critically ill infants and children.

This record should be cited as:

Joffe A, Anton N, Lequier L, Vandermeer B, Tjosvold L, Larsen B, Hartling L. Nutritional support for critically ill children. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD005144. DOI: 10.1002/14651858.CD005144.pub2

Assessed as up to date:

February 16, 2007

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Anaesthesia Group

Health topics:

Anaesthesia & pain control > Post-anaesthetic unit/intensive care unit > Circulatory care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Nutrition for critically ill children in paediatric intensive care units

More like this

Copyright © 2011 - The Cochrane Collaboration