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nutrition in critically ill children

W Philip T James
BACKGROUND: This analysis sets out an overview of an IUNS presentation of a European clinician's assessment of the challenges of coping with immediate critical clinical problems and how to use metabolic and a mechanistic understanding of disease when developing nutritional policies. SUMMARY: Critically ill malnourished children prove very sensitive to both mineral and general nutritional overload, but after careful metabolic control they can cope with a high-quality, energy-rich diet provided their initial lactase deficiency and intestinal atrophy are taken into account...
March 8, 2018: Annals of Nutrition & Metabolism
Heitor Pons Leite, Lúcio Flávio Peixoto de Lima, José Augusto de A C Taddei, Ângela Tavares Paes
OBJECTIVE: To test the hypothesis that low blood thiamine concentrations in malnourished critically ill children are associated with higher risk of 30-d mortality. METHODS: Prospective cohort study in 202 consecutively admitted children who had whole blood thiamine concentrations assessed on admission and on days 5 and 10 of intensive care unit (ICU) stay. The primary outcome variable was 30-d mortality. Mean blood thiamine concentrations within the first 10 d of ICU stay, age, sex, malnutrition, C-reactive protein concentration, Pediatric Index of Mortality 2 score, and severe sepsis/septic shock were the main potential exposure variables for outcome...
December 7, 2017: Nutrition
Sören Verstraete, Ilse Vanhorebeek, Esther van Puffelen, Inge Derese, Catherine Ingels, Sascha C Verbruggen, Pieter J Wouters, Koen F Joosten, Jan Hanot, Gonzalo G Guerra, Dirk Vlasselaers, Jue Lin, Greet Van den Berghe
BACKGROUND: Children who have suffered from critical illnesses that required treatment in a paediatric intensive care unit (PICU) have long-term physical and neurodevelopmental impairments. The mechanisms underlying this legacy remain largely unknown. In patients suffering from chronic diseases hallmarked by inflammation and oxidative stress, poor long-term outcome has been associated with shorter telomeres. Shortened telomeres have also been reported to result from excessive food consumption and/or unhealthy nutrition...
February 21, 2018: Critical Care: the Official Journal of the Critical Care Forum
Esther Arendt, Neha S Singh, Oona M R Campbell
RATIONALE: The lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes...
2018: PloS One
Yara M F Moreno, Daniela B Hauschild, Mayara D Martins, Lori J Bechard, Nilesh M Mehta
BACKGROUND: We describe the protein type and concentration in standard enteral nutrition (EN) formulas and the effect of protein supplementation on the osmolality of standard formulas. We also aimed to examine factors associated with optimal protein delivery in critically ill children. METHODS: Protein content and other characteristics of pediatric EN formulas used worldwide were recorded. Factors associated with achievement of recommended protein delivery and tolerance of protein-supplemented formulas were recorded prospectively in a cohort of critically ill children...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Esther van Puffelen, Suzanne Polinder, Ilse Vanhorebeek, Pieter Jozef Wouters, Niek Bossche, Guido Peers, Sören Verstraete, Koen Felix Maria Joosten, Greet Van den Berghe, Sascha Cornelis Antonius Theodorus Verbruggen, Dieter Mesotten
BACKGROUND: The multicentre randomised controlled PEPaNIC trial showed that withholding parenteral nutrition (PN) during the first week of critical illness in children was clinically superior to providing early PN. This study describes the cost-effectiveness of this new nutritional strategy. METHODS: Direct medical costs were calculated with use of a micro-costing approach. We compared the costs of late versus early initiation of PN (n = 673 versus n = 670 patients) in the Belgian and Dutch study populations from a hospital perspective, using Student's t test with bootstrapping...
January 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
Soyhan Baǧci, Elif Keleş, Feyza Girgin, Dinçer R Yıldızdaş, Özden Ö Horoz, Nilüfer Yalındağ, Murat Tanyıldız, Benan Bayrakçi, Gökhan Kalkan, Başak N Akyıldız, Alper Köker, Tolga Köroğlu, Ayşe B Anıl, Neslihan Zengin, Ener Ç Dinleyici, Eylem Kıral, Oğuz Dursun, Süleyman Tolga Yavuz, Peter Bartmann, Andreas Müller
AIM: Although early enteral nutrition (EN) is strongly associated with lower mortality in critically ill children, there is no consensus on the definition of early EN. The aim of this study was to evaluate our current practice supplying EN and to identify factors that affect both the initiation of feeding within 24 h after paediatric intensive care unit (PICU) admission and the adequate supply of EN in the first 48 h after PICU admission in critically ill children. METHODS: We conducted a prospective, multicentre, observational study in nine PICUs in Turkey...
December 26, 2017: Journal of Paediatrics and Child Health
Kelly W Muraya, Caroline Jones, James A Berkley, Sassy Molyneux
Gender roles and relations play an important role in child health and nutritional status. While there is increasing recognition of the need to incorporate gender analysis in health planning and programme development, there has been relatively little attention paid to the gendered nature of child nutrition interventions. This qualitative study undertaken in rural Coastal Kenya aimed to explore the interaction between household gender relations and a community-based child nutrition programme, with a focus on household decision-making dynamics related to joining the intervention...
December 1, 2017: Health Policy and Planning
Frédéric V Valla, Julien Berthiller, Bénédicte Gaillard-Le-Roux, Carole Ford-Chessel, Tiphanie Ginhoux, Shancy Rooze, Fleur Cour-Andlauer, Rosan Meyer, Etienne Javouhey
Low body mass index (BMI) z score is commonly used to define undernutrition, but faltering growth allows for a complementary dynamic assessment of nutritional status. We studied the prevalence of undernutrition and faltering growth at admission in the pediatric intensive care (PICU) setting and their impacts on outcome. All (685) consecutive children (aged 0 to 18 years old) admitted in a single-center PICU over a 1-year period were prospectively enrolled. Nutritional status assessment was based on anthropometric measurements performed at admission and collected from medical files...
March 2018: European Journal of Pediatrics
Peter J McGlynn, Andre μΝ Renzaho, Minh D Pham, Mike Toole, Jane Fisher, Stanley Luchters
BACKGROUND AND OBJECTIVES: Undernutrition remains a significant cause of childhood illness, poor growth, development, and death in Papua New Guinea (PNG). Studies on child nutritional outcomes in PNG vary by design, measurement protocols and quality. We conducted a systematic review to assess the evidence for the prevalence of child undernutrition across different study populations, geographical locations and time periods. METHODS AND STUDY DESIGN: Six electronic databases and additional grey literature were searched for articles describing the nutritional status by wasting, stunting and underweight, of PNG children under five years of age, published between 1990 and April 2015...
2018: Asia Pacific Journal of Clinical Nutrition
Rulla Al-Araji, Rafeeq Muhammed
No abstract text is available yet for this article.
December 1, 2017: Archives of Disease in Childhood. Education and Practice Edition
Duy T Dao, Lorenzo Anez-Bustillos, Bennet S Cho, Zhilling Li, Mark Puder, Kathleen M Gura
Micronutrients refer to a group of organic vitamins and inorganic trace elements that serve many functions in metabolism. Assessment of micronutrient status in critically ill children is challenging due to many complicating factors, such as evolving metabolic demands, immature organ function, and varying methods of feeding that affect nutritional dietary intake. Determination of micronutrient status, especially in children, usually relies on a combination of biomarkers, with only a few having been established as a gold standard...
October 28, 2017: Nutrients
Chengsi Ong, Jan Hau Lee, Melvin K S Leow, Zudin A Puthucheary
Evidence suggests that critically ill children develop muscle wasting, which could affect outcomes. Muscle ultrasound has been used to track muscle wasting and association with outcomes in critically ill adults but not children. This review aims to summarize methodological considerations of muscle ultrasound, structural findings, and possibilities for its application in the assessment of nutrition and functional outcomes in critically ill children. Medline, Embase, and CINAHL databases were searched up until April 2016...
September 2017: JPEN. Journal of Parenteral and Enteral Nutrition
Noémi Kreif, Linh Tran, Richard Grieve, Bianca deStavola, Robert C Tasker, Maya Petersen
Longitudinal data sources offer new opportunities for the evaluation of sequential interventions. To adjust for time-dependent confounding in these settings, longitudinal targeted maximum likelihood based estimation (TMLE), a double-robust method that can be coupled with machine learning, has been proposed. This paper provides a tutorial in applying longitudinal TMLE, in contrast to inverse probability of treatment weighting and g-computation based on iterative conditional expectations. We apply these methods to estimate the causal effect of nutritional interventions on clinical outcomes of critically ill children...
June 24, 2017: American Journal of Epidemiology
Valentina De Cosmi, Gregorio Paolo Milani, Alessandra Mazzocchi, Veronica D'Oria, Marco Silano, Edoardo Calderini, Carlo Agostoni
The metabolic response to stress and infection is closely related to the corresponding requirements of energy and nutrients. On a general level, the response is driven by a complex endocrine network and related to the nature and severity of the insult. On an individual level, the effects of nutritional interventions are highly variable and a possible source of complications. This narrative review aims to discuss the metabolic changes in critically-ill children and the potential of developing personalized nutritional interventions...
September 18, 2017: Nutrients
Lyvonne N Tume, Anna Bickerdike, Lynne Latten, Simon Davies, Madeleine H Lefèvre, Gaëlle W Nicolas, Frédéric V Valla
Critically ill children frequently fail to achieve adequate energy intake, and some care practices, such as the measurement of gastric residual volume (GRV), may contribute to this problem. We compared outcomes in two similar European Paediatric Intensive Care Units (PICUs): one which routinely measures GRV (PICU-GRV) to one unit that does not (PICU-noGRV). An observational pilot comparison study was undertaken. Eighty-seven children were included in the study, 42 (PICU-GRV) and 45 (PICU-noGRV). There were no significant differences in the percentage of energy targets achieved in the first 4 days of PICU admission although PICU-noGRV showed more consistent delivery of median (and IQR) energy targets and less under and over feeding for PICU-GRV and PICU-noGRV: day 1 37 (14-72) vs 44 (0-100), day 2 97 (53-126) vs 100 (100-100), day 3 84 (45-112) vs 100 (100-100) and day 4 101 (63-124) vs 100 (100-100)...
December 2017: European Journal of Pediatrics
Ahmed Nabih El Shazly, Doaa Refaey Soliman, Effat Hussien Assar, Eman Gamal Behiry, Ibrahim Abd El Naby Gad Ahmed
BACKGROUND: Hypophosphatemia is one of the common disorders that develop in critically ill patients. It has potential complications and is often unrecognized in those patients. OBJECTIVE: Determining the incidence of hypophosphatemia in critically ill children, its association with clinical outcomes and the possible risk factors. METHODS: 50 patients were enrolled in the study. Levels of serum phosphate were measured on day 1 and day 7 of PICU (Pediatric intensive care unit) stay...
September 2017: Annals of Medicine and Surgery
Amanda B Hassinger, Ryan K Breuer, Kirsten Nutty, Chang-Xing Ma, Omar S Al Ibrahim
BACKGROUND: The objective of this work was to describe the use of negative-pressure ventilation (NPV) in a heterogeneous critically ill, pediatric population. METHODS: A retrospective chart review was conducted of all patients admitted to a pediatric ICU with acute respiratory failure supported with NPV from January 1, 2012 to May 15, 2015. RESULTS: Two hundred thirty-three subjects at a median age of 15.5 months were supported with NPV for various etiologies, most commonly bronchiolitis (70%)...
August 31, 2017: Respiratory Care
Matthew K Leroue, Ryan J Good, Heather E Skillman, Angela S Czaja
OBJECTIVES: Evaluate the practice of providing enteral nutrition in critically ill children requiring noninvasive positive pressure ventilation. DESIGN: Retrospective cohort study. SETTING: PICU within a quaternary care children's hospital. PATIENTS: PICU patients older than 30 days requiring noninvasive positive pressure ventilation for greater than or equal to 24 hours from August 2014 to June 2015. Invasive mechanical ventilation prior to noninvasive positive pressure ventilation and inability to receive enteral nutrition at baseline were additional exclusionary criteria...
December 2017: Pediatric Critical Care Medicine
Donata Maria de Souza Pellegrino, Julieta Maria Ferreira Chacon, Leila Blanes, Lydia Masako Ferreira
OBJECTIVE: To identify the incidence and prevalence of pressure injuries (PIs) in children admitted to hospitals in the city of São Paulo, and assess the association between sociodemographic and clinical characteristics with hospital-acquired pressure injuries (HAPIs). MATERIALS AND METHODS: A total of 543 children were evaluated, and their sociodemographic and clinical data were recorded. Student's t, Wilcoxon, chi-square, and Fisher's exact tests were used to assess associations between risk factors and the occurrence of HAPIs...
July 12, 2017: Journal of Tissue Viability
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