Briassoulis George, Filippou Olga, Hatzi Eugenia, Papassotiriou Ioannis, Hatzis Tassos
Pediatric Intensive Care Unit, University Hospital of Heraklion, Crete, Greece; Pediatric Intensive Care Medicine, Aghia Sophia Children's Hospital, Athens, Greece.
Nutrition. 2005 Jul-Aug;21(7-8):799-807. doi: 10.1016/j.nut.2004.12.006.
In a blinded, prospective, randomized, controlled clinical trial, we compared nitrogen balance (NB), nutritional indices, antioxidant catalysts, and outcome in critically ill children given an immune-enhancing formula (I) or conventional early enteral nutrition (C).
Fifty patients, 103 +/- 7 months old, with disorders prompting admission to the pediatric intensive care unit, including sepsis, respiratory failure, and severe head injury, were enrolled in the study. Within 12 h of admission, patients were randomized to receive I (n=25) or C (n=25). Caloric intake was aimed at meeting patient's predicted basal metabolic rate by day 2 and predicted energy expenditure by day 4, irrespective of group assignment. Outcome endpoints and complications were recorded; NB, transthyretin, retinol-binding protein, transferrin, zinc, copper, and metabolic indices were measured on days 1 and 5 and compared with clinical and nutritional characteristics within and between groups.
Both diets achieved their initial targets of covering predicted basal metabolic rate by day 2 and predicted energy expenditure by day 4. Twenty four-hour NB became positive in 40% of patients in group C and occurred in 64% of patients in group I by day 5. Only in group I did the mean NB become positive by day 5 (0.07+/-0.07 g/kg versus -0.24+/-0.03 g/kg on day 1, P<0.001) compared with group C in which the mean NB remained negative (-0.06+/-0.04 g/kg versus -0.25+/-0.06 g/kg on day 1, P<0.001). By day 5, nutritional indices and antioxidant catalysts showed a higher increasing trend in group I compared with group C and higher osmolality (P<0.02), sodium (P<0.03), and urea (P<0.04). Diarrhea for group I (P<0.02) and gastric distention for group C (P<0.04) were the most frequently recorded complications. Mortality or length of stay did not differ between groups, but there was a trend for less gastric gram plus isolates (P<0.05) or for Candida species (P<0.04) and nosocomial infections in group I compared with group C.
Although less well tolerated, immunonutrition is a feasible method of early enteral nutrition in the pediatric intensive care unit. It has a favorable effect on nutritional indices and antioxidant catalysts, but not on outcome hard endpoints. Although it poses a higher metabolic burden to the patient, it shows a trend to improve colonization and infection rates. Appropriate modifications for specific age populations might improve its tolerability and benefits among critically ill children.
在一项双盲、前瞻性、随机对照临床试验中，我们比较了接受免疫增强型配方奶粉（I组）或传统早期肠内营养（C组）的危重症儿童的氮平衡（NB）、营养指标、抗氧化催化剂及预后情况。
50例年龄为103±7个月、因包括脓毒症、呼吸衰竭和重度颅脑损伤等疾病而入住儿科重症监护病房的患儿纳入本研究。入院12小时内，将患儿随机分为I组（n = 25）或C组（n = 25）。无论分组情况如何，热量摄入目标是在第2天达到患儿预计基础代谢率，在第4天达到预计能量消耗。记录预后终点和并发症；在第1天和第5天测量NB、转甲状腺素蛋白、视黄醇结合蛋白、转铁蛋白、锌、铜及代谢指标，并与组内和组间的临床及营养特征进行比较。
两种饮食均在第2天达到覆盖预计基础代谢率、第4天达到预计能量消耗的初始目标。到第5天，C组40%的患儿24小时NB转为正值，I组64%的患儿24小时NB转为正值。仅I组在第5天时平均NB转为正值（第1天为0.07±0.07 g/kg，第5天为 - 0.24±0.03 g/kg，P<0.001），而C组平均NB仍为负值（第1天为 - 0.06±0.04 g/kg，第5天为 - 0.25±0.06 g/kg，P<0.001）。到第5天，与C组相比，I组的营养指标和抗氧化催化剂呈现出更高的上升趋势，且渗透压（P<0.02）、钠（P<0.03）和尿素（P<0.04）更高。I组腹泻（P<0.02）和C组胃扩张（P<0.04）是最常记录到的并发症。两组间死亡率或住院时间无差异，但与C组相比，I组胃革兰氏阳性菌分离株（P<0.05）、念珠菌属（P<0.04）及医院感染有减少趋势。
尽管耐受性较差，但免疫营养是儿科重症监护病房早期肠内营养的一种可行方法。它对营养指标和抗氧化催化剂有有利影响，但对预后硬终点无影响。尽管它给患者带来更高的代谢负担，但显示出改善定植和感染率的趋势。针对特定年龄人群进行适当调整可能会提高其在危重症儿童中的耐受性和益处。
