Division of Critical Care, Department of Pediatrics, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
Department of Surgery, University of Washington, Seattle, WA, USA.
Neurocrit Care. 2019 Feb;30(1):193-200. doi: 10.1007/s12028-018-0597-6.
Traumatic brain injury (TBI) is the leading cause of death and long-term disability among injured children. Early feeding has been shown to improve outcomes in adults, with some similar evidence in children with severe TBI. We aimed to examine the current practice of initiation of enteral nutrition in children with TBI and to evaluate the risk factors associated with delayed initiation of enteral nutrition.
This retrospective, multicenter study used the Pediatric Trauma Assessment and Management Database including all children with head trauma discharged from five pediatric intensive care units (PICU) at pediatric trauma centers between January 1, 2013 and December 31, 2013. We compared demographics, injury and procedure data, time to initiation of nutrition, and injury and illness severity scores between patients who received enteral nutrition early (≤ 48 h) and late (> 48 h). Fisher's exact and Mann-Whitney U tests compared discrete and continuous variables. Univariate and multivariable analyses evaluated variables associated with delayed initiation of feeding. Outcomes of interest included mortality, complications, ventilator days, hospital and ICU length of stay, and functional status at ICU discharge.
In the 416 patients in the study, the overall mortality was 2.6%. The majority of patients (83%; range 69-88% between five sites, p = 0.0008) received enteral nutrition within 48 h of PICU admission. Lower Glasgow Coma Scale scores and higher Injury Severity Score (ISS) were independently associated with delayed initiation of enteral nutrition. Delayed enteral nutrition was independently associated with worse functional status at PICU discharge (p = 0.02) but was not associated with mortality or increased length of stay.
Children with severe TBI and higher ISS were more likely to have delayed initiation of enteral nutrition. Delayed enteral nutrition was an independent risk factor for worse functional status at ICU discharge for the entire cohort, but not for the severe TBI group.
颅脑损伤（TBI）是受伤儿童死亡和长期残疾的主要原因。早期喂养已被证明可改善成人的预后，在严重 TBI 儿童中也有一些类似的证据。我们旨在检查 TBI 患儿肠内营养启动的现状，并评估与肠内营养启动延迟相关的危险因素。
本回顾性多中心研究使用了儿科创伤评估和管理数据库，其中包括 2013 年 1 月 1 日至 2013 年 12 月 31 日期间，从 5 个儿科创伤中心的 5 个儿科重症监护病房（PICU）出院的所有头部外伤患儿。我们比较了接受早期（≤48 小时）和晚期（>48 小时）肠内营养的患者的人口统计学、损伤和程序数据、营养开始时间以及损伤和疾病严重程度评分。离散变量和连续变量分别采用 Fisher 确切检验和 Mann-Whitney U 检验。单变量和多变量分析评估了与喂养延迟相关的变量。研究的主要结果包括死亡率、并发症、呼吸机使用天数、住院和 ICU 住院时间以及 ICU 出院时的功能状态。
在 416 例研究患者中，总体死亡率为 2.6%。大多数患者（83%；5 个中心的范围为 69-88%，p=0.0008）在 PICU 入院后 48 小时内接受肠内营养。较低的格拉斯哥昏迷量表评分和较高的损伤严重程度评分（ISS）与肠内营养延迟启动独立相关。延迟肠内营养与 PICU 出院时的功能状态较差独立相关（p=0.02），但与死亡率或住院时间延长无关。
严重 TBI 和更高 ISS 的儿童更有可能延迟开始肠内营养。延迟肠内营养是整个队列中 ICU 出院时功能状态较差的独立危险因素，但不是严重 TBI 组的独立危险因素。
