Jan Hau Lee1, Elizabeth Rogers2, Yek Kee Chor3, Rujipat Samransamruajkit4, Pei Lin Koh5, Mohamad Miqdady6, Ali Ibrahim Al-Mehaidib7, Antonius Pudjiadi8, Sunit Singhi9, Nilesh M Mehta10. 1. Children's Intensive Care Unit, KK Women's and Children's Hospital, and Office of Clinical Sciences, Duke-NUS School of Medicine, Singapore. Email: lee.jan.hau@singhealth.com.sg. 2. Department of Nutrition and Food Services, Royal Children's Hospital, Melbourne, Australia. 3. Sarawak General Hospital, Malaysia. 4. Division of Paediatric Pulmonary and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 5. Paediatric Critical Care and Paediatric Haematology- Oncology Divisions of Department of Paediatrics, Khoo Teck Puat- National University Children's Medical Institute, National University Hospital, Singapore. 6. Paediatric Gastroenterology, Hepatology and Nutrition, Sheikh Khalifa Medical City, United Arab Emirates. 7. Paediatric Gastroenterology and Nutrition, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. 8. Paediatric Critical Care Division, Department of Child Health, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. 9. Department of Paediatrics, Advanced Paediatrics Center, Postgraduate Institute of Medical Education and Research, India. 10. Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital Boston, United States.
Abstract
BACKGROUND AND OBJECTIVES: Current practices and available resources for nutrition therapy in paediatric intensive care units (PICUs) in the Asia Pacific-Middle East region are expected to differ from western countries. Existing guidelines for nutrition management in critically ill children may not be directly applicable in this region. This paper outlines consensus statements developed by the Asia Pacific-Middle East Consensus Working Group on Nutrition Therapy in the Paediatric Critical Care Environment. Challenges and recommendations unique to the region are described. METHODS AND STUDY DESIGN: Following a systematic literature search from 2004-2014, consensus statements were developed for key areas of nutrient delivery in the PICU. This review focused on evidence applicable to the Asia Pacific-Middle East region. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach. RESULTS: Enteral nutrition (EN) is the preferred mode of nutritional support. Feeding algorithms that optimize EN should be encouraged and must include: assessment and monitoring of nutritional status, selection of feeding route, time to initiate and advance EN, management strategies for EN intolerance and indications for using parenteral nutrition (PN). Despite heterogeneity in nutritional status of patients, availability of resources and diversity of cultures, PICUs in the region should consider involvement of dieticians and/or nutritional support teams. CONCLUSIONS: Robust evidence for several aspects of optimal nutrition therapy in PICUs is lacking. Nutritional assessment must be implemented to document prevalence and impact of malnutrition. Nutritional support must be given greater priority in PICUs, with particular emphasis in optimizing EN delivery.
BACKGROUND AND OBJECTIVES: Current practices and available resources for nutrition therapy in paediatric intensive care units (PICUs) in the Asia Pacific-Middle East region are expected to differ from western countries. Existing guidelines for nutrition management in critically ill children may not be directly applicable in this region. This paper outlines consensus statements developed by the Asia Pacific-Middle East Consensus Working Group on Nutrition Therapy in the Paediatric Critical Care Environment. Challenges and recommendations unique to the region are described. METHODS AND STUDY DESIGN: Following a systematic literature search from 2004-2014, consensus statements were developed for key areas of nutrient delivery in the PICU. This review focused on evidence applicable to the Asia Pacific-Middle East region. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach. RESULTS: Enteral nutrition (EN) is the preferred mode of nutritional support. Feeding algorithms that optimize EN should be encouraged and must include: assessment and monitoring of nutritional status, selection of feeding route, time to initiate and advance EN, management strategies for EN intolerance and indications for using parenteral nutrition (PN). Despite heterogeneity in nutritional status of patients, availability of resources and diversity of cultures, PICUs in the region should consider involvement of dieticians and/or nutritional support teams. CONCLUSIONS: Robust evidence for several aspects of optimal nutrition therapy in PICUs is lacking. Nutritional assessment must be implemented to document prevalence and impact of malnutrition. Nutritional support must be given greater priority in PICUs, with particular emphasis in optimizing EN delivery.
Authors: Esther van Puffelen; Jessie M Hulst; Ilse Vanhorebeek; Karolijn Dulfer; Greet Van den Berghe; Sascha C A T Verbruggen; Koen F M Joosten Journal: JAMA Netw Open Date: 2018-09-07