Søiland Elisabeth, Glenton Claire, Munabi-Babigumira Susan, Nordheim Lena Victoria, Lakudzala Suzgika, Kallon Idriss Ibrahim, Naude Celeste, Brand Amanda, Lewin Simon, Mbeye Nyanyiwe Masingi
Section for Evidence-Based Practice, Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.
Evidence Informed Decision-making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
BMC Nutr. 2025 May 19;11(1):98. doi: 10.1186/s40795-025-01077-3.
This review aims to explore factors associated with the provision of enteral nutrition in critically ill children in intensive care. Critically ill children are at risk of becoming malnourished, which can lead to poorer outcomes such as longer hospital stays, increased readmissions, and increased mortality. Optimal enteral feeding can help prevent and manage malnutrition.
We searched MEDLINE, CINAHL, Embase, and Scopus from inception to July 3, 2023. We included qualitative studies and mixed-methods studies. As we anticipated few studies in critical care settings, we included studies that focused on experiences and perceptions of any stakeholders involved in enteral feeding in children in any hospital setting to provide indirect evidence. Titles, abstracts and potentially eligible full-text records were independently assessed. We extracted descriptive data and used a thematic analysis approach to synthesise the study data. We used the GRADE-CERQual approach to assess our confidence in each finding.
We included 14 studies, with four from critical care settings. Where we had concerns that the context of the studies may be less relevant to the setting, intervention and population of interest, we indicated this inour GRADE-CERQual assessment. We had moderate, low or very low confidence in our findings, in part due to the indirectness of the evidence. Moderate confidence findings indicated that parents were concerned about discomfort and side effects, and that a lack of resources could be a barrier to providing optimal nutritional support. Low confidence findings suggested that healthcare workers lacked the knowledge and skills to provide adequate nutritional support, and that receiving support, information, and participating in decision-making around enteral feeding was important to some parents.
Our review points to several factors that may influence the provision of enteral feeding for critically ill children. More qualitative research on healthcare workers' nutritional support practices, particularly in critical care settings, is needed to provide a better understanding of the barriers to optimal enteral feeding in critically ill children.
本综述旨在探讨与重症监护病房中危重症儿童肠内营养提供相关的因素。危重症儿童有营养不良的风险，这可能导致诸如住院时间延长、再入院率增加和死亡率升高等更差的结局。最佳的肠内喂养有助于预防和管理营养不良。
我们检索了MEDLINE、CINAHL、Embase和Scopus数据库，检索时间从建库至2023年7月3日。我们纳入了定性研究和混合方法研究。由于我们预计重症监护环境下的研究较少，因此纳入了关注任何医院环境中参与儿童肠内喂养的任何利益相关者的经验和看法的研究，以提供间接证据。对标题、摘要和可能符合条件的全文记录进行独立评估。我们提取了描述性数据，并采用主题分析方法来综合研究数据。我们使用GRADE-CERQual方法评估我们对每个发现的信心。
我们纳入了14项研究，其中4项来自重症监护环境。如果我们担心研究背景可能与感兴趣的环境、干预措施和人群不太相关，我们会在GRADE-CERQual评估中指出这一点。我们对研究结果的信心为中等、低或非常低，部分原因是证据的间接性。信心中等的研究结果表明，家长担心不适和副作用，资源匮乏可能是提供最佳营养支持的障碍。信心低的研究结果表明，医护人员缺乏提供充分营养支持的知识和技能，获得支持、信息以及参与围绕肠内喂养的决策对一些家长来说很重要。
我们的综述指出了几个可能影响危重症儿童肠内喂养提供的因素。需要对医护人员的营养支持实践进行更多定性研究，尤其是在重症监护环境中，以更好地了解危重症儿童最佳肠内喂养的障碍。
