Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
Pediatric Gastroenterology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
Clin Nutr. 2020 Mar;39(3):685-693. doi: 10.1016/j.clnu.2019.03.026. Epub 2019 Mar 30.
BACKGROUND & AIMS: Clinicians and researchers often use feeding intolerance (FI) as main cause for insufficient enteral nutrition (EN). However, there is no uniform definition for FI. A uniform definition is essential for future studies focusing on predictors and outcomes of FI and enteral nutrition. A systematic review was performed to investigate the definitions, prevalence, predictors and outcomes of FI in critically ill children.
The databases Medline, Embase, Cochrane CENTRAL, Web of Science were searched. Inclusion criteria were interventional, observational or case-control studies (>10 patients) in which a definition of FI was reported in critically ill children (0-21 years).
FI was defined in 31 unique studies performed in 2973 critically ill children. FI was most commonly defined as presence of gastrointestinal (GI) symptoms and/or large gastric residual volume (GRV) (n = 21), followed by discontinuation of EN due to GI symptoms (n = 7) and inadequate delivery of EN (n = 3). Median prevalence of FI was 20.0% [IQR 7.4%-33.0%]. Large GRV, abdominal distention, diarrhoea and vomiting/emesis, were the predominantly reported GI symptoms to define FI. FI was associated with severity of illness, mortality and nosocomial infections.
Feeding intolerance is inconsistently defined in the current literature, but appears to be a prevalent concern in critically ill children. FI is most frequently defined by the presence of GI symptoms. A standardized definition is needed for both clinical and research purpose to determine the consequences of FI in relation to short-term and long-term outcomes. The new proposed definition for FI entails the inability to achieve enteral nutrition target intakes in combination with the presence of GI symptoms indicating GI dysfunction.
PROSPERO registration number: CRD42018092967. Registered on 07 June 2018.
临床医生和研究人员常将喂养不耐受（FI）作为肠内营养（EN）摄入不足的主要原因。然而，FI 尚无统一的定义。对于未来聚焦于 FI 和 EN 预测因素及结局的研究，统一的定义至关重要。本系统综述旨在调查危重症患儿 FI 的定义、发生率、预测因素和结局。
检索 Medline、Embase、Cochrane 中心数据库、Web of Science 数据库。纳入标准为：报道了危重症儿童 FI 定义的干预性、观察性或病例对照研究（＞10 例）。
31 项研究共纳入 2973 例危重症患儿，FI 定义各不相同。最常通过胃肠道（GI）症状和/或胃残留量（GRV）较大（n=21）来定义 FI，其次是因 GI 症状停止 EN（n=7）和 EN 供给不足（n=3）。FI 的中位发生率为 20.0%[四分位距（IQR）7.4%-33.0%]。GRV 较大、腹胀、腹泻和呕吐/呕出是最常报道的用于定义 FI 的 GI 症状。FI 与疾病严重程度、死亡率和医院感染相关。
目前文献中 FI 的定义不一致，但在危重症患儿中似乎是一个普遍问题。最常通过 GI 症状定义 FI。为了临床和研究目的，需要制定 FI 的标准化定义，以确定 FI 与短期和长期结局的关系。FI 的新定义是指无法达到肠内营养目标摄入量，同时存在 GI 功能障碍的 GI 症状。
PROSPERO 注册号：CRD42018092967。注册日期：2018 年 6 月 7 日。
