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Pediatric critical care nutrition

Joseph A Carcillo, J Michael Dean, Richard Holubkov, John Berger, Kathleen L Meert, Kanwaljeet J S Anand, Jerry J Zimmerman, Christopher J L Newth, Rick Harrison, Jeri Burr, Douglas F Willson, Carol Nicholson, Michael J Bell, Robert A Berg, Thomas P Shanley, Sabrina M Heidemann, Heidi Dalton, Tammara L Jenkins, Allan Doctor, Angie Webster, Robert F Tamburro
BACKGROUND AND AIMS: The pediatric Critical Illness Stress-induced Immune Suppression (CRISIS) trial compared the effectiveness of 2 nutraceutical supplementation strategies and found no difference in the development of nosocomial infection and sepsis in the overall population. We performed an exploratory post hoc analysis of interaction between nutraceutical treatments and host immune status related to the development of nosocomial infection/sepsis. METHODS: Children from the CRISIS trial were analyzed according to 3 admission immune status categories marked by decreasing immune competence: immune competent without lymphopenia, immune competent with lymphopenia, and previously immunocompromised...
September 22, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
B L Fang, S Y Qian, X L Jia, Z Li, J Liu
OBJECTIVE: To analyze the interruptions of enteral nutrition (EN) and it's relationship to prognosis in children with sepsis in pediatric intensive care unit (PICU). METHOD: Daily EN intake and reasons for EN interruptions were prospectively observed and recorded in children with sepsis who were admitted to our PICU from November 2012 to April 2013. Clinical prognosis was compared between children with and without EN interruptions by t, rank-sum and χ(2) tests...
September 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Alejandro A Floh, Julie Slicker, Steven M Schwartz
OBJECTIVES: The objectives of this review are to discuss the challenges of delivering adequate nutrition to children with congenital heart disease, including pre- and postoperative factors and the role of enteral and parenteral nutrition, as well as the evidence supporting current practices. DATA SOURCE: MEDLINE and PubMed. CONCLUSION: Providing adequate nutritional support is paramount for critically ill infants with congenital heart disease, a population at particular risk for malnutrition...
August 2016: Pediatric Critical Care Medicine
Rafaela B Grippa, Paola S Silva, Eliana Barbosa, Nilzete L Bresolin, Nilesh M Mehta, Yara M F Moreno
OBJECTIVES: Critically ill children admitted to the pediatric intensive care unit (PICU) often are malnourished. The aim of this study was to determine the role of nutritional status on admission as a predictor of the duration of mechanical ventilation in critically ill children. METHODS: This was a single-center, prospective cohort study, including consecutive children (ages 1 mo to 15 y) admitted to a PICU. Demographic characteristics, clinical characteristics, and nutritional status were recorded and patients were followed up until hospital discharge...
May 17, 2016: Nutrition
Amy E Caruso Brown, Edwin J Asturias, Mario Melgar, Federico A Antillon-Klussmann, Pamela Mettler, Myron J Levin
BACKGROUND: Varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children, despite treatment with antiviral agents. Universal varicella vaccine programs have significantly decreased this risk in many highincome countries, but in most low-income and middleincome countries, the burden of varicella in children treated for malignancy is poorly defined. METHODS: We retrospectively reviewed records of children at the National Unit of Pediatric Oncology (UNOP) in Guatemala diagnosed with varicella between January 2009 and March 2013 in order to calculate incidence of varicella and evaluate morbidity, mortality, treatment interruption, and cost...
August 2016: World Journal of Pediatrics: WJP
Roberto J N Nogueira, José E Godoy, Tiago H Souza
Vitamin B1 (thiamine) plays a fundamental role in the proper functioning of the nervous and cardiovascular systems and in glucose metabolism. Because of the inability of the human body to store large amounts of vitamin, continuous restoration through diet is necessary. In the pediatric population, thiamine deficiency has a broad spectrum of clinical presentations, making diagnosis difficult. In this article, we report the case of a 7-month-old child with thiamine deficiency presented with neurological symptoms and simulation of acute abdomen...
June 20, 2016: Journal of Tropical Pediatrics
Enid E Martinez, Nilesh M Mehta
PURPOSE OF REVIEW: Nutritional status and nutrient delivery during critical illness impact clinical outcomes. We have reviewed recent studies that may guide best practices regarding nutrition therapy in critically ill children. RECENT FINDINGS: Malnutrition is prevalent in the pediatric ICU population, and is associated with worse outcomes. Nutrition support teams, dedicated dietitians, and educational programs facilitate surveillance for existing malnutrition and nutrition risk, but specific tools for the pediatric ICU population are lacking...
August 2016: Current Opinion in Critical Care
Ari Joffe, Natalie Anton, Laurance Lequier, Ben Vandermeer, Lisa Tjosvold, Bodil Larsen, Lisa Hartling
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. This is an update of a review that was originally published in 2009. . OBJECTIVES: The objective of this review was to assess the impact of enteral and parenteral nutrition given in the first week of illness on clinically important outcomes in critically ill children...
2016: Cochrane Database of Systematic Reviews
Mathilde Kersting, Ute Alexy, Susanne Schürmann
The adequacy of a diet is usually evaluated based on nutrient intake. As people eat foods but not nutrients, food-based dietary guidelines (FBDG) are needed. To evaluate dietary habits in infants and young children, the following stepwise approach is suggested: (1) develop country-specific FBDG to identify the potential of common nonfortified foods to ensure adequate nutrient intake and (2) examine potential 'critical' dietary patterns if main food groups are excluded, such as in vegetarian diets or if a family's precarious social status leads to food constraints...
2016: World Review of Nutrition and Dietetics
Melissa Van Arsdall, Ikram Haque, Yuying Liu, J Marc Rhoads
Twenty years ago, there was profound, international interest in developing oral human, bovine, or chicken egg-derived immunoglobulin (Ig) for the prevention and nutritional treatment of childhood malnutrition and gastrointestinal disease, including acute diarrhea and necrotizing enterocolitis. Although such Ig products were shown to be effective, with both nutritional and antidiarrheal benefits, interest waned because of their cost and because of the perceived risk of bovine serum encephalitis (BSE). BSE is no longer considered a barrier to use of oral Ig, because the WHO has declared the United States to be BSE-free since the early 2000s...
May 2016: Advances in Nutrition
Ursula G Kyle, Laura A Lucas, Guisela Mackey, Jaime C Silva, Jennifer Lusk, Renan Orellana, Lara S Shekerdemian, Jorge A Coss-Bu
BACKGROUND: Critically ill children are at risk of developing malnutrition, and undernutrition is a risk factor for morbidity and mortality. OBJECTIVE: The study evaluated changes in the energy and protein intake before and after implementation of nutrition support (NS) guidelines for a pediatric critical care unit (PICU). DESIGN: This retrospective study documented energy and protein intake for the first 8 days of PICU stay. Basal metabolic rate and protein needs were estimated by Schofield and American Society for Parenteral and Enteral Nutrition Guidelines, respectively...
May 2016: Journal of the Academy of Nutrition and Dietetics
Miriam Isabel Souza Dos Santos Simon, Gabriele Carra Forte, Juliane da Silva Pereira, Elenara da Fonseca Andrade Procianoy, Michele Drehmer
BACKGROUND: In cystic fibrosis (CF), nutrition diagnosis is of critical relevance because the early identification of nutrition-related compromise enables early, adequate intervention and, consequently, influences patient prognosis. Up to now, there has not been a validated nutrition screening tool that takes into consideration clinical variables. OBJECTIVE: To validate a specific nutritional risk screening tool for patients with CF based on clinical variables, anthropometric parameters, and dietary intake...
May 2016: Journal of the Academy of Nutrition and Dietetics
Sunit C Singhi, Suresh Kumar
Gut microflora contribute greatly to immune and nutritive functions and act as a physical barrier against pathogenic organisms across the gut mucosa. Critical illness disrupts the balance between host and gut microflora, facilitating colonization, overgrowth, and translocation of pathogens and microbial products across intestinal mucosal barrier and causing systemic inflammatory response syndrome and sepsis. Commonly used probiotics, which have been developed from organisms that form gut microbiota, singly or in combination, can restore gut microflora and offer the benefits similar to those offered by normal gut flora, namely immune enhancement, improved barrier function of the gastrointestinal tract (GIT), and prevention of bacterial translocation...
2016: F1000Research
Yara M F Moreno, Daniela B Hauschild, Eliana Barbosa, Nilzete L Bresolin, Nilesh M Mehta
BACKGROUND: Optimal nutrition therapy (NT) delivery is associated with improved outcomes in critically ill children. However, avoidable barriers impede delivery of optimal energy and protein in the pediatric intensive care unit (PICU). This study aims to describe the gap between energy and protein prescription and actual intake. METHODS: Single-center prospective cohort study, including consecutive children (age: 1 month to 15 years) admitted to the PICU in southern Brazil...
October 2016: Nutrition in Clinical Practice
Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P Casaer, Gonzalo Garcia Guerra, Jan Hanot, Ari Joffe, Dick Tibboel, Koen Joosten, Greet Van den Berghe
BACKGROUND: Recent trials have questioned the benefit of early parenteral nutrition in adults. The effect of early parenteral nutrition on clinical outcomes in critically ill children is unclear. METHODS: We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding parenteral nutrition for 1 week (i.e., providing late parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early parenteral nutrition...
March 24, 2016: New England Journal of Medicine
Judith Ju-Ming Wong, Wee Meng Han, Rehena Sultana, Tsee Foong Loh, Jan Hau Lee
BACKGROUND: Malnutrition is prevalent in critically ill children. We aim to describe nutrition received by children with acute respiratory distress syndrome (ARDS) and to determine whether provision of adequate nutrition is associated with improved clinical outcomes. MATERIALS AND METHODS: We studied characteristics and outcomes of 2 groups of patients: (1) those who received adequate calories (defined as ≥80% of predicted resting energy expenditure) and (2) those who received adequate protein (defined as ≥1...
March 9, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Caroline A D Costa, Cristian T Tonial, Pedro Celiny R Garcia
OBJECTIVES: To systematically review the evidence about the impact of nutritional status in critically-ill pediatric patients on the following outcomes during hospitalization in pediatric intensive care units: length of hospital stay, need for mechanical ventilation, and mortality. DATA SOURCE: The search was carried out in the following databases: Lilacs (Latin American and Caribbean Health Sciences), MEDLINE (National Library of Medicine United States) and Embase (Elsevier Database)...
May 2016: Jornal de Pediatria
Jian Ji, Suyun Qian, Jie Yan
OBJECTIVE: To determine the resting energy expenditure on mechanical ventilation in pediatric intensive care unit (PICU) by indirect calorimetry, and analyze the distribution of metabolic states. The nutrition supply was assessed according to the resting energy expenditure. METHOD: An observational study which was held in PICU of Beijing Children's Hospital from November 2013 to April 2014. Critically ill children with mechanical ventilation were enrolled in this study...
January 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Huee Jin Park, Kyung Hoon Kim, Hyuk Jin Lee, Eui Cheol Jeong, Kee Won Kim, Dong In Suh
Compartment syndrome is a rare but devastating condition that can result in permanent neuromuscular or soft tissue injuries. Extravasation injuries, among the iatrogenic causes of compartment syndrome, occur under a wide variety of circumstances in the inpatient setting. Total parenteral nutrition via a peripheral route is an effective alternative for the management of critically ill children who do not obtain adequate nutrition via the oral route. However, there is an inherent risk of extravasation, which can cause compartment syndrome, especially when detected at a later stage...
November 2015: Korean Journal of Pediatrics
Jeffrey A Alten, Leslie A Rhodes, Sarah Tabbutt, David S Cooper, Eric M Graham, Nancy Ghanayem, Bradley S Marino, Mayte I Figueroa, Nikhil K Chanani, Jeffrey P Jacobs, Janet E Donohue, Sunkyung Yu, Michael Gaies
UNLABELLED: Introduction The optimal perioperative feeding strategies for neonates with CHD are unknown. In the present study, we describe the current feeding practices across a multi-institutional cohort. METHODS: Inclusion criteria for this study were as follows: all neonates undergoing cardiac surgery admitted to the cardiac ICU for ⩾24 hours preoperatively between October, 2013 and July, 2014 in the Pediatric Cardiac Critical Care Consortium registry. RESULTS: The cohort included 251 patients from eight centres...
December 2015: Cardiology in the Young
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