Department of Dietetics/Speech & Language Therapy, NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and School of Health Sciences, University of Southampton, Southampton, UK.
Paediatric Intensive Care Unit, Hôpital Femme Mère Enfant, CarMEN INSERM UMR 1060 Hospices Civils de Lyon, Lyon-Bron, France.
Clin Nutr. 2020 Dec;39(12):3571-3593. doi: 10.1016/j.clnu.2020.04.015. Epub 2020 Apr 22.
No evidence based recommendations for micronutrient requirements during paediatric critical illness are available, other than those arising from recommended nutrient intakes (RNI) for healthy children and expert opinion.
The objective of this review is to examine the available evidence from micronutrient status in critically ill children considering studies which describe 1) micronutrient levels, 2) associations between micronutrient levels and clinical outcome, and 3) impact on clinical outcome with micronutrient supplementation during PICU admission.
Scoping review.
Any study which used a qualitative and quantitative design considering causes and consequences of micronutrient levels or micronutrient supplementation during paediatric critical illness.
NICE Healthcare Databases Advanced Search website (https://hdas.nice.org.uk/) was used as a tool for multiple searches, with a content analysis and charting of data extracted.
711 records were identified, 35 were included in the review. Studies evaluated serum micronutrient status was determined on admission day in majority of patients. A content analysis identified (n = 49) initial codes, (n = 14) sub-categories and (n = 5) overarching themes during critical illness, which were identified as: i) low levels of micronutrients, ii) causes of aberrant micronutrient levels, iii) associations between micronutrients levels and outcome, iv) supplementation of micronutrients.
During critical illness, micronutrients should be provided in sufficient amounts to meet reference nutrient intakes for age. Although, there is insufficient data to recommend routine supplementations of micronutrients at higher doses during critical illness, the 'absence of evidence should not imply evidence of absence', and well designed prospective studies are urgently needed to elucidate paediatric micronutrient requirements during critical illness. The absence of reliable biomarkers make it challenging to determine whether low serum levels are reflective of a true deficiency or as a result redistribution, particularly during the acute phase of critical illness. As more children continue to survive a PICU admission, particularly those with complex diseases micronutrient supplementation research should also be inclusive of the recovery phase following critical illness.
目前尚无针对儿科危重症患者微量营养素需求的循证推荐，除了健康儿童的推荐营养素摄入量（RNI）和专家意见之外。
本综述的目的是检查危重症儿童微量营养素状态的现有证据，考虑描述 1）微量营养素水平、2）微量营养素水平与临床结局之间的关联，以及 3）在 PICU 入院期间补充微量营养素对临床结局的影响的研究。
范围综述。
任何使用定性和定量设计考虑儿科危重症期间微量营养素水平或微量营养素补充的原因和后果的研究。
使用 NICE Healthcare Databases Advanced Search 网站（https://hdas.nice.org.uk/）作为多种搜索的工具，对数据进行内容分析和图表绘制。
确定了 711 条记录，其中 35 条被纳入综述。大多数患者在入院当天评估血清微量营养素状态。内容分析确定了（n=49）初始代码、（n=14）子类别和（n=5）危重病期间的总体主题，分别为：i）微量营养素水平低，ii）异常微量营养素水平的原因，iii）微量营养素水平与结局之间的关联，iv）微量营养素补充。
在危重病期间，应提供足够数量的微量营养素以满足年龄的参考营养素摄入量。尽管目前尚无足够的数据推荐在危重病期间以更高剂量常规补充微量营养素，但“缺乏证据不应意味着缺乏证据”，迫切需要进行精心设计的前瞻性研究，以阐明危重病期间儿科微量营养素需求。缺乏可靠的生物标志物使得确定低血清水平是否反映真正的缺乏或由于再分布而导致的缺乏变得具有挑战性，尤其是在危重病的急性期。随着越来越多的儿童继续在 PICU 接受治疗，特别是那些患有复杂疾病的儿童，微量营养素补充研究也应包括危重病后的康复阶段。
