Postgraduate Program "Emergency and Intensive Care in Children Adolescents and Young Adults", School of Medicine, University of Crete, Section 6D (Delta), Office 03, Voutes, 71003 Heraklion, Greece.
Paediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece.
Nutrients. 2024 Oct 17;16(20):3523. doi: 10.3390/nu16203523.
Nutrition significantly impacts the outcomes of critically ill children in intensive care units (ICUs). Due to the evolving metabolic, neuroendocrine, and immunological disorders associated with severe illness or trauma, there are dynamically changing phases of energy needs requiring tailored macronutrient intake.
This study aims to assess the changing dietary needs from the acute phase through recovery, provide recommendations for implementing evidence-based strategies to ensure adequate energy and nutrient provision in pediatric ICUs, and optimize patient outcomes.
A comprehensive search of the MEDLINE-PubMed database was conducted, focusing on randomized controlled trials, meta-analyses, and systematic reviews related to the nutrition of critically ill children. The study highlights recent guidelines using the GRADE approach, supplemented by relevant adult studies, current clinical practices, challenges, gaps in knowledge, and future directions for research aimed at improving nutritional interventions.
Early personalized, incremental enteral feeding helps mitigate the negative energy balance during the acute phase, aids organ function restoration in the stabilization phase, and supports growth during the recovery phase and beyond. Conversely, early full nutritional support, high protein doses, or isolated micronutrient administration have not demonstrated benefits due to anabolic resistance in these patients. Moreover, early parenteral nutrition during the acute phase may suppress autophagy and lead to worse outcomes. Accurate assessment of nutritional status and monitoring of daily energy and protein needs are crucial.
Strong evidence supports the establishment of a dedicated nutritional team and the implementation of individualized nutritional protocols in the ICU to reduce morbidity and mortality in critically ill children.
营养对重症监护病房（ICU）中危重病儿童的结局有重要影响。由于与严重疾病或创伤相关的代谢、神经内分泌和免疫紊乱不断演变，能量需求存在动态变化的阶段，需要量身定制的宏量营养素摄入。
本研究旨在评估从急性期到恢复期的不断变化的饮食需求，为实施循证策略提供建议，以确保儿科 ICU 中提供充足的能量和营养素，并优化患者结局。
对 MEDLINE-PubMed 数据库进行全面检索，重点关注与危重病儿童营养相关的随机对照试验、荟萃分析和系统评价。本研究强调了使用 GRADE 方法的最新指南，并辅以相关的成人研究、当前的临床实践、知识空白以及未来的研究方向，旨在改善营养干预。
早期个性化、增量肠内喂养有助于减轻急性期的负能平衡，有助于稳定期的器官功能恢复，并在恢复期及以后支持生长。相反，早期全营养支持、高蛋白剂量或单独给予微量营养素并没有显示出益处，因为这些患者存在合成代谢抵抗。此外，急性期的早期肠外营养可能会抑制自噬并导致更差的结局。准确评估营养状况和监测每日能量和蛋白质需求至关重要。
有强有力的证据支持在 ICU 中建立专门的营养团队和实施个体化营养方案，以降低危重病儿童的发病率和死亡率。
