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Critically ill children nutrition rct

Nilesh M Mehta, Heather E Skillman, Sharon Y Irving, Jorge A Coss-Bu, Sarah Vermilyea, Elizabeth Anne Farrington, Liam McKeever, Amber M Hall, Praveen S Goday, Carol Braunschweig
This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and <18 years) expected to require a length of stay >2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance...
May 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
Peter J M Weijs
PURPOSE OF REVIEW: Protein delivery in the critically ill still is a highly debated issue. Here, we discuss only the most recent updates in the literature concerning protein nutrition of the critically ill. RECENT FINDINGS: Up to now, there are no randomized controlled trials (RCTs) published on enteral provision of protein that were randomized for protein level of intake. In the past year, there have been two new observational studies published, one of which in critically ill children...
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
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
Koen Joosten, Esther van Puffelen, Sascha Verbruggen
PURPOSE OF REVIEW: This article describes the current best available evidence on optimal nutrition in the paediatric intensive care based on different levels of outcome, which can be divided in surrogate and hard clinical outcome parameters. RECENT FINDINGS: Undernutrition is associated with increased morbidity and mortality, whereas in specific cohorts of critically ill children, such as those with burn injury, obesity is associated with more complications, longer length of stay, and decreased likelihood of survival...
March 2016: Current Opinion in Clinical Nutrition and Metabolic Care
Iva Hojsak, Virginie Colomb, Christian Braegger, Jiri Bronsky, Cristina Campoy, Magnus Domellöf, Nicholas Embleton, Nataša Fidler Mis, Jessie M Hulst, Flavia Indrio, Alexandre Lapillonne, Walter Mihatsch, Christian Molgaard, Johannes van Goudoever, Mary Fewtrell
The aim of the present article was to perform a systematic review with meta-analysis of available scientific evidence regarding the role of different intravenous lipid emulsions (ILE) in the pathogenesis of cholestasis and parenteral nutrition-associated liver disease. A systematic review of the literature (up to March 2015) identified 23 randomized controlled trials (RCTs). Of these, 17 were performed in preterm infants or critically ill neonates with a short duration of intervention, 2 in older children with short-term use (following surgery or bone marrow transplantation), 1 in neonates with long-term use, and 3 in infants and children receiving long-term parenteral nutrition (PN)...
May 2016: Journal of Pediatric Gastroenterology and Nutrition
Thirimon Moe-Byrne, Jennifer V E Brown, William McGuire
BACKGROUND: Glutamine is a conditionally essential amino acid. Endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Evidence exists that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may also benefit preterm infants. OBJECTIVES: To determine the effects of glutamine supplementation on mortality and morbidity in preterm infants. SEARCH METHODS: We used the standard search strategy of the Cochrane Neonatal Review Group...
2016: Cochrane Database of Systematic Reviews
Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Koen Joosten, Greet Van den Berghe
BACKGROUND AND AIMS: During hospitalization in a pediatric intensive care unit (PICU), critically ill children are fed artificially. Administered via the preferred enteral route, caloric targets are often not reached. Hence, parenteral nutrition is given to this patient population. In this review we analyzed the available evidence from randomized controlled trials (RCTs) that supports the use of parenteral nutrition in children during critical illness. METHODS: A search strategy in Ovid MEDLINE and Ovid EMBASE was created and trial registries were screened to identify the relevant RCTs...
February 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Tom Fivez, Dorian Kerklaan, Sascha Verbruggen, Ilse Vanhorebeek, Sören Verstraete, Dick Tibboel, Gonzalo Garcia Guerra, Pieter J Wouters, Ari Joffe, Koen Joosten, Dieter Mesotten, Greet Van den Berghe
BACKGROUND: The state-of-the-art nutrition used for critically ill children is based essentially on expert opinion and extrapolations from adult studies or on studies in non-critically ill children. In critically ill adults, withholding parenteral nutrition (PN) during the first week in ICU improved outcome, as compared with early supplementation of insufficient enteral nutrition (EN) with PN. We hypothesized that withholding PN in children early during critical illness reduces the incidence of new infections and accelerates recovery...
May 1, 2015: Trials
Chengsi Ong, Wee Meng Han, Judith Ju-Ming Wong, Jan Hau Lee
BACKGROUND & AIMS: Malnutrition can significantly affect clinical outcomes in critically ill children. In view of the limitations of anthropometry, nutrition-related serum biomarkers have been used to assess the degree of malnutrition in the pediatric intensive care unit. The aim of this review is to critically appraise the use of nutrition-related serum biomarkers in predicting clinical outcomes in critically ill children. METHODS: We searched major databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) using MeSH terms and key words related to "biomarkers", "nutrition" and "critically ill children"...
April 2014: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Fernanda Marchetto da Silva, Ana Carolina Gouvea Bermudes, Ivie Reis Maneschy, Graziela de Araújo Costa Zanatta, Rubens Feferbaum, Werther Brunow de Carvalho, Uenis Tannuri, Artur Figueiredo Delgado
OBJECTIVE: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit. METHODS: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition...
November 2013: Revista da Associação Médica Brasileira
Mark Duffett, Karen Choong, Lisa Hartling, Kusum Menon, Lehana Thabane, Deborah J Cook
INTRODUCTION: Evidence from randomized controlled trials (RCTs) is required to guide treatment of critically ill children, but the number of RCTs available is limited and the publications are often difficult to find. The objectives of this review were to systematically identify RCTs in pediatric critical care and describe their methods and reporting. METHODS: We searched MEDLINE, EMBASE, LILACS and CENTRAL (from inception to April 16, 2013) and reference lists of included RCTs and relevant systematic reviews...
October 29, 2013: Critical Care: the Official Journal of the Critical Care Forum
Judith Ju-Ming Wong, Chengsi Ong, Wee Meng Han, Jan Hau Lee
Enteral nutrition (EN) protocols are thought to improve clinical outcomes in the pediatric intensive care unit (PICU); however, critical evaluation of their efficacy is limited. We conducted a systematic review with the aim of assessing the effect of EN protocols on important clinical outcomes in these children. We searched MEDLINE, Cochrane Database for Reviews, Embase, and CINAHL using predetermined keywords and MESH terms. We included randomized controlled trials (RCTs) and observational studies that involved EN protocols in children admitted to the PICU for >24 hours...
January 2014: JPEN. Journal of Parenteral and Enteral Nutrition
Lora L Iannotti, Indi Trehan, Mark J Manary
BACKGROUND: World Health Organization (WHO) guidelines recommend for children with severe acute malnutrition (SAM), high-dose vitamin A (VA) supplements be given on day 1 of admission, and on days 2 and 14 in the case of clinical signs of vitamin A deficiency (VAD). Daily low-dose VA follows, delivered in a premix added to F-75 and F-100. This study aimed to systematically review the evidence for safety and effectiveness of high-dose VA supplementation (VAS) in treatment of children with SAM...
2013: Nutrition Journal
Jennifer C Seida, Diana R Mager, Lisa Hartling, Ben Vandermeer, Justine M Turner
BACKGROUND: There is growing interest in the use of ω-3 fatty acid (n-3FA) lipid emulsions to prevent complications associated with parenteral nutrition. The authors systematically reviewed the evidence on the benefits and safety of n-3FA compared with standard lipid emulsions in children with intestinal disease, critical illness, trauma, or postoperative complications. MATERIALS AND METHODS: The authors searched 4 bibliographic databases from their inception to March 2011, conference proceedings, trial registries, and reference lists...
January 2013: JPEN. Journal of Parenteral and Enteral Nutrition
Clare van Miert, Rebecca Hill, Leanne Jones
BACKGROUND: Central venous catheters (CVCs) facilitate the administration of intravenous drugs, fluids, blood products and parenteral nutrition to patients with either chronic disease or critical illness. Despite a pivotal role within medical management, a common complication associated with CVC use is occlusion of the CVC lumen(s). CVC occlusion can interrupt and cause serious delays in administration of treatment interventions. OBJECTIVES: The primary objective of this review was to assess the efficacy and safety of different interventions used to restore patency of occluded CVC lumens, in adults and children...
2012: Cochrane Database of Systematic Reviews
Banani Poddar
UNLABELLED: NEED AND PURPOSE OF REVIEW: Hyperglycemia is prevalent among critically ill pediatric patients. Previously thought to be an adaptive response to stress, hyperglycemia is now recognized to be associated with an adverse outcome. Correction of such hyperglycemia with insulin infusion has been shown to improve outcome but carries risk of hypoglycemia. This review addresses these issues related to treatment of hyperglycemia. METHODS: A Pubmed search was performed using the search strategy: (hyperglycemia OR blood glucose OR insulin therapy) AND (critical illness OR critical care OR intensive care unit)...
July 2011: Indian Pediatrics
Conrad R Cole
No abstract text is available yet for this article.
July 2011: Journal of Pediatrics
Marta Botrán, Jesús López-Herce, Santiago Mencía, Javier Urbano, Maria José Solana, Ana García
OBJECTIVE: To compare a standard diet and a protein-enriched diet in critically ill children. STUDY DESIGN: In this prospective randomized controlled trial in critically ill children, all patients received enteral nutrition exclusively and were randomly assigned to a standard diet or a protein-enriched diet (1.1 g protein/100 mL of feeding formula). Blood and urine tests, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry were performed before the beginning of the nutrition regimen and at 24 hours, 72 hours, and 5 days after initiation...
July 2011: Journal of Pediatrics
Kalia P Ulate
OBJECTIVE: To review findings and discuss implications of strict glycemic control in children. DESIGN: Critical appraisal of a randomized controlled trial. FINDINGS: This is the largest prospective randomized controlled trial to date, comparing intensive insulin therapy (glycemic targets: 50.4-79.2 mg/dL [2.8-4.4 mmol/L] and 70.2-99 mg/dL [3.9-5.5 mmol/L] [for infants and children, respectively]) and conventional insulin therapy (target: 180-215 mg/dl [10-11...
July 2011: Pediatric Critical Care Medicine
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