Enteral Nutrition Articles & Resources

Unfortunately, until recently, critically ill children were poorly fed and nutrition was not of concern in the intensive care of these patients. During these critical times, there is a loss of body mass, predominantly lean tissue. This problem is exacerbated by the typical decline in food intake. Nutrition support may buy time necessary for the basic disease-related problems to improve, and give the patient an edge during the period of convalescence.

Although it is generally accepted that early enteral nutrition is beneficial in critically ill children, there is no evidence to prove this. Therefore a study was performed to determine if early achievement of energy and protein balance improved NB and somatic protein status during post-stress catabolic illness in children. Seventy-one. mechanically ventilated, critically ill children served as subjects. In order to be included in the study patients had to meet the following criteria: 1) expected PICU-dependency of five days or more; 2) mechanical ventilation of more than 24 hours; 3) no chronic renal disease; 4) no history of chronic gastrointestinal disease; 5) enteral feedings starting within the first 12 hr of admission. A standard pediatric formula (Nutrison Pediatric) was given to patients less than 10 years of age and a standard adult formula (Standard) was given to patients greater than 10 years of age. Enteral feeds were delivered through a nasogastric tube starting from the first 12 hours of admission. Researchers aimed to meet the patient's PBMR by the 2nd day of the critical illness, and to exceed that by 50% afterwards. Protein Recommended Dietary Allowances (RDA) were met by day 2 and doubled that value thereafter.

Data collected included demographics, clinical diagnoses, and vital signs. Patients were classified a priori into the following diagnostic categories: sepsis, brain injury, respiratory failure, neuromuscular disease, and burns. Stress mediators measured were the acute-phase proteins CRP and fibrinogen. Also, among the biochemical indices of nutritional assessment, the visceral albumins pre-albumin and transferrin were determined. All subjects had urinary catheters that allowed for accurate urine collection. Twenty-four hour urine collections were started on the first day of enteral nutrition. Urine output was collected for 24 hours measurements of urinary urea nitrogen (N) and creatinine excretion. From the 24 hr urine creatinine excretion, the creatinine height index was calculated.

Results revealed subjects to have severe depletion of somatic protein status on stress day 1 (CHI<60) but they reached the normal range of somatic protein status at the end of the enteral nutrition, on post-stress day 5 (CHI>80%, p<.004). On day 1, none of the patients had positive NB but after five days of enteral nutrition, 44 (62%) had positive nitrogen balance and only 27 (38%) had negative NB ().

Investigators conclude that the above results indicate that achievement of positive protein and energy balance in relation to the basic metabolic rate using aggressive early enteral nutrition improves nitrogen balance during the acute phase of stress in two out of three critically ill children.

G. Briassoulis, A. Tsorva, N. Zavras, et al. Influence of an aggressive early' enteral nutrition protocol on nitrogen balance in critically ill children. Journal of Nutritional Biochemistry 13:560-569 (September, 2002). [Correspondence: G. Briassoulis. Phone: +30-01-6040436. Fax: +30-01-6041773.