Xue-Mei Zhu1, Su-Yun Qian2, Guo-Ping Lu1, Feng Xu3, Ying Wang4, Chun-Feng Liu5, Xiao-Xu Ren6, Yu-Cai Zhang7, Heng-Miao Gao8, Tao Zhou9, Hong-Xing Dang3, Chong-Fan Zhang1,9, Yi-Min Zhu10. 1. Children's Hospital, Fudan University, No. 399 Wanyuan Road, Minhang District, 201100, Shanghai, China. 2. Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan-li-shi Road, Xicheng District, 100045, Beijing, China. syqian1211@163.com. 3. Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, 400010, Chongqing, China. 4. Shanghai Children's Medical Center, No. 1678, DongFang Road, 200127, Shanghai, China. 5. Shengjing Hospital of China Medical University, No.36 Sanhao Road, 110004, Shenyang, China. 6. The Capital Institute of Pediatrics, No. 2 Yabao Road, 100020, Beijing, China. 7. Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 355 Luding Road, 200062, Shanghai, China. 8. Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan-li-shi Road, Xicheng District, 100045, Beijing, China. 9. Boai Hospital of Zhongshan Affiliated to Southern Medical University, 6 Chenggui Road, East District, 528400, Zhongshan, China. 10. Hunan Provincial People's Hospital, No. 60 Jiefang West Road, 410005, Changsha, China.
Abstract
BACKGROUND: This document represents the first evidence-based guidelines to describe best practices in nutrition therapy in critically ill children (> 1 month and < 18 years), who are expected to require a length of stay more than 2 or 3 days in a Pediatric Intensive Care Unit admitting medical patients domain. METHODS: A total of 25,673 articles were scanned for relevance. After careful review, 88 studies appeared to answer the pre-identified questions for the guidelines. We used the grading of recommendations, assessment, development and evaluation criteria to adjust the evidence grade based on the quality of design and execution of each study. RESULTS: The guidelines emphasise the importance of nutritional assessment, particularly the detection of malnourished patients. Indirect calorimetry (IC) is recommended to estimate energy expenditure and there is a creative value in energy expenditure, 50 kcal/kg/day for children aged 1-8 years during acute phase if IC is unfeasible. Enteral nutrition (EN) and early enteral nutrition remain the preferred routes for nutrient delivery. A minimum protein intake of 1.5 g/kg/day is suggested for this patient population. The role of supplemental parenteral nutrition (PN) has been highlighted in patients with low nutritional risk, and a delayed approach appears to be beneficial in this group of patients. Immune-enhancing cannot be currently recommended neither in EN nor PN. CONCLUSION: Overall, the pediatric critically ill population is heterogeneous, and an individualized nutrition support with the aim of improving clinical outcomes is necessary and important.
BACKGROUND: This document represents the first evidence-based guidelines to describe best practices in nutrition therapy in critically ill children (> 1 month and < 18 years), who are expected to require a length of stay more than 2 or 3 days in a Pediatric Intensive Care Unit admitting medical patients domain. METHODS: A total of 25,673 articles were scanned for relevance. After careful review, 88 studies appeared to answer the pre-identified questions for the guidelines. We used the grading of recommendations, assessment, development and evaluation criteria to adjust the evidence grade based on the quality of design and execution of each study. RESULTS: The guidelines emphasise the importance of nutritional assessment, particularly the detection of malnourished patients. Indirect calorimetry (IC) is recommended to estimate energy expenditure and there is a creative value in energy expenditure, 50 kcal/kg/day for children aged 1-8 years during acute phase if IC is unfeasible. Enteral nutrition (EN) and early enteral nutrition remain the preferred routes for nutrient delivery. A minimum protein intake of 1.5 g/kg/day is suggested for this patient population. The role of supplemental parenteral nutrition (PN) has been highlighted in patients with low nutritional risk, and a delayed approach appears to be beneficial in this group of patients. Immune-enhancing cannot be currently recommended neither in EN nor PN. CONCLUSION: Overall, the pediatric critically ill population is heterogeneous, and an individualized nutrition support with the aim of improving clinical outcomes is necessary and important.
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