Optimising energy and protein intake in critically ill children
The need for evidence-based research to mitigate risks in PICU
A systematic review is underway to evaluate the effectiveness of high vs lower enteral protein intake on clinical and nutritional outcomes in critically ill children hospitalised in the paediatric intensive care unit (PICU). The review will have a clear separation between different age groups, and reporting energy intake.
Nutrition is crucial for critically ill children in PICU. Most critically ill children in the PICU require enteral nutrition due to inability to eat orally. Underfeeding or overfeeding in critically ill children increases the risk of morbidity, prolonged mechanical ventilation, longer PICU stay, and higher mortality risk. The negative effects of unbalanced energy intake during PICU on neurocognitive development may manifest up to 2 years after hospitalisation.
For many years, the energy and protein intake recommended for critically ill children has been higher than the recommended intake for healthy children, based on critically ill adult data, which showed that metabolic stress due to critical illness induced an increase in resting energy expenditure (hypermetabolism) and nitrogen losses (hypercatabolism).
Observational studies in mechanically ventilated, critically ill children have shown that minimum energy intake required for energy balance is significantly lower than recommended for healthy children.
The studies also showed that urinary nitrogen loss, a surrogate for protein needs, is higher in critically ill children compared to healthy children, and protein intake required to maintain nitrogen balance is higher in critically ill children than in healthy children.
Just as the optimal dose of a medication is determined based on pharmacological research, optimal energy and protein intake must be determined based on evidence-based nutritional research data.
However, scarce data exist on energy and protein needs of critically ill patients in PICU, highlighting the need for further investigation
The aim of the systematic review is to increase our understanding of the impact of high vs lower protein intake on clinical outcomes considering energy intake, and to clarify this impact on different age groups hospitalised in PICU, including newborns, infants, children, and adolescents.
This evidence-based research may contribute to the establishment of evidence-based nutritional guidelines for critically ill children of different age groups, to help ensure optimal energy and protein intake based on their specific needs, and mitigate the risks associated with overfeeding and underfeeding.
The protocol for the systematic review that is currently underway is published in the June 2023 issue of JBI Evidence Synthesis:
Jotterand Chaparro, Corinne; Bertoni Maluf, Valeria; Moullet, Clémence; Kiszio, Blanche; Pugliese, Marie-Thérèse; Ramelet, Anne-Sylvie; Morice, Claire; Valla, Frédéric V; Tume, Lyvonne N.
JBI Evidence Synthesis 21(6):p 1251-1258, June 2023. | DOI: 10.11124/JBIES-22-00133