Mikhailov Theresa A, Kuhn Evelyn M, Manzi Jennifer, Christensen Melissa, Collins Maureen, Brown Ann-Marie, Dechert Ronald, Scanlon Matthew C, Wakeham Martin K, Goday Praveen S
Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin.
JPEN J Parenter Enteral Nutr. 2014 May;38(4):459-66. doi: 10.1177/0148607113517903. Epub 2014 Jan 8.
The purpose of this study was to examine the association of early enteral nutrition (EEN), defined as the provision of 25% of goal calories enterally over the first 48 hours of admission, with mortality and morbidity in critically ill children.
We conducted a multicenter retrospective study of patients in 12 pediatric intensive care units (PICUs). We included patients aged 1 month to 18 years who had a PICU length of stay (LOS) of ≥96 hours for the years 2007-2008. We obtained patients' demographics, weight, Pediatric Index of Mortality-2 (PIM2) score, LOS, duration of mechanical ventilation (MV), mortality data, and nutrition intake data in the first 4 days after admission.
We identified 5105 patients (53.8% male; median age, 2.4 years). Mortality was 5.3%. EEN was achieved by 27.1% of patients. Children receiving EEN were less likely to die than those who did not (odds ratio, 0.51; 95% confidence interval, 0.34-0.76; P = .001 [adjusted for propensity score, PIM2 score, age, and center]). Comparing those who received EEN to those who did not, adjusted for PIM2 score, age, and center, LOS did not differ (P = .59), and the duration of MV for those receiving EEN tended to be longer than for those who did not, but the difference was not significant (P = .058).
EEN is strongly associated with lower mortality in patients with PICU LOS of ≥96 hours. LOS and duration of MV are slightly longer in patients receiving EEN, but the differences are not statistically significant.
本研究旨在探讨早期肠内营养（EEN）与危重症儿童死亡率和发病率之间的关联，EEN定义为入院后首48小时内通过肠内途径提供25%的目标热量。
我们对12个儿科重症监护病房（PICU）的患者进行了一项多中心回顾性研究。纳入2007 - 2008年在PICU住院时间（LOS）≥96小时的1个月至18岁患者。我们获取了患者的人口统计学资料、体重、儿童死亡率指数-2（PIM2）评分、LOS、机械通气（MV）持续时间、死亡率数据以及入院后前4天的营养摄入数据。
我们确定了5105例患者（53.8%为男性；中位年龄2.4岁）。死亡率为5.3%。27.1%的患者实现了EEN。接受EEN的儿童死亡可能性低于未接受EEN的儿童（优势比，0.51；95%置信区间，0.34 - 0.76；P = 0.001[经倾向评分、PIM2评分、年龄和中心校正后，P = 0.001]）。在根据PIM2评分、年龄和中心进行校正后，比较接受EEN的患者与未接受EEN的患者，LOS无差异（P = 0.59），接受EEN的患者MV持续时间往往比未接受EEN的患者长，但差异无统计学意义（P = 0.058）。
EEN与PICU LOS≥96小时患者的较低死亡率密切相关。接受EEN的患者LOS和MV持续时间略长，但差异无统计学意义。
