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DOI: 10.1055/s-0041-1736146
Nutritional Intake in Children with Septic Shock: A Retrospective Single-Center Study
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Abstract
Nutritional practice in children with severe sepsis or septic shock remains poorly described. We aimed to describe nutrition received by children with severe sepsis or septic shock and explore the association of nutritional intake with clinical outcomes. This study was a retrospective study of children who required pediatric intensive care unit (PICU) admission from 2009 to 2016. Outcomes were mortality, ventilator-free days (VFDs), and PICU-free days (IFDs). A total of 74 patients with septic shock or severe sepsis were identified. Forty-one (55.4%) patients received enteral nutrition (EN) only, 6 (8.1%) patients received parental nutrition (PN) only, 15 (20.3%) patients received both EN and PN, and 12 (16.2%) patients received intravenous fluids alone. Eight of 74 (10.8%) and 4 of 74 (5.4%) had adequate energy and protein intake, respectively. Patients who received early EN had lower odds of 28-day mortality (adjusted hazard ratio [HR] = 0.09, 95% confidence interval [CI]: 0.02, 0.45, p = 0.03) more 28-day VFDs (adjusted β-coefficient = 18.21 [95% CI: 11.11, 25.32], p < 0.001), and IFDs (adjusted ß-coefficient = 16.71 [95% CI: 9.86, 23.56], p < 0.001) than patients who did not receive EN. Late EN was also associated with lower odds of mortality, more VFDs, and IFDs compared with no EN (HR = 0.06, 95% CI: 0.02, 0.23; p < 0.001; adjusted β coefficient = 15.66, 95% CI: 9.31, 22.02; p < 0.001; and 12.34 [95% CI: 6.22, 18.46], p < 0.001; respectively). Inadequate calories and protein were not associated with mortality. EN in children with septic shock or severe sepsis was associated with improved clinical outcomes. Future prospective studies are required to explore the impact of EN timing and optimal nutritional intake in these children.
Note
This study was approved by the Institutional Review Board of SingHealth with a waiver of informed consent due to the retrospective nature of the study. The data used and analyzed for this study are available from the corresponding author on reasonable request.
Publication History
Received: 14 June 2021
Accepted: 13 August 2021
Article published online:
21 September 2021
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References
- 1 Weiss SL, Fitzgerald JC, Pappachan J. et al; Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med 2015; 191 (10) 1147-1157
- 2 Balamuth F, Weiss SL, Neuman MI. et al. Pediatric severe sepsis in U.S. children's hospitals. Pediatr Crit Care Med 2014; 15 (09) 798-805
- 3 Tan B, Wong JJ-M, Sultana R. et al. Global case-fatality rates in pediatric severe sepsis and septic shock: a systematic review and meta-analysis. JAMA Pediatr 2019; 173 (04) 352-362
- 4 World Health Organization. Improving the prevention, diagnosis and clinical management of sepsis: report by the Secretariat. Accessed August 4, 2021 at: https://apps.who.int/iris/bitstream/handle/10665/273181/B140_12-en.pdf?sequence=1&isAllowed=y
- 5 Mehta NM, Bechard LJ, Cahill N. et al. Nutritional practices and their relationship to clinical outcomes in critically ill children–an international multicenter cohort study. Crit Care Med 2012; 40 (07) 2204-2211
- 6 Larsen BMK, Beggs MR, Leong AY, Kang SH, Persad R, Garcia Guerra G. Can energy intake alter clinical and hospital outcomes in PICU?. Clin Nutr ESPEN 2018; 24: 41-46
- 7 Wong JJ-M, Han WM, Sultana R, Loh TF, Lee JH. Nutrition delivery affects outcomes in pediatric acute respiratory distress syndrome. JPEN J Parenter Enteral Nutr 2017; 41 (06) 1007-1013
- 8 Carré JE, Singer M. Cellular energetic metabolism in sepsis: the need for a systems approach. Biochim Biophys Acta 2008; 1777 (7-8): 763-771
- 9 Elke G, Kott M, Weiler N. When and how should sepsis patients be fed?. Curr Opin Clin Nutr Metab Care 2015; 18 (02) 169-178
- 10 Tume LN, Valla FV, Joosten K. et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med 2020; 46 (03) 411-425
- 11 Leong AY, Cartwright KR, Guerra GG, Joffe AR, Mazurak VC, Larsen BM. A Canadian survey of perceived barriers to initiation and continuation of enteral feeding in PICUs. Pediatr Crit Care Med 2014; 15 (02) e49-e55
- 12 Wong JJ, Ong C, Han WM, Mehta NM, Lee JH. Survey of contemporary feeding practices in critically ill children in the Asia-Pacific and the Middle East. Asia Pac J Clin Nutr 2016; 25 (01) 118-125
- 13 Meyers RS. Pediatric fluid and electrolyte therapy. J Pediatr Pharmacol Ther 2009; 14 (04) 204-211
- 14 Mehta NM, Compher C. A.S.P.E.N. Board of Directors. A.S.P.E.N. Clinical Guidelines: nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr 2009; 33 (03) 260-276
- 15 Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6 (01) 2-8
- 16 Bechard LJ, Parrott JS, Mehta NM. Systematic review of the influence of energy and protein intake on protein balance in critically ill children. J Pediatr 2012; 161 (02) 333-9.e1
- 17 Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014; 311 (13) 1308-1316
- 18 Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29 (07) 1303-1310
- 19 McIntosh AM, Tong S, Deakyne SJ, Davidson JA, Scott HF. Validation of the vasoactive-inotropic score in pediatric sepsis. Pediatr Crit Care Med 2017; 18 (08) 750-757
- 20 Haque A, Siddiqui NR, Munir O, Saleem S, Mian A. Association between vasoactive-inotropic score and mortality in pediatric septic shock. Indian Pediatr 2015; 52 (04) 311-313
- 21 Mikhailov TA, Kuhn EM, Manzi J. et al. Early enteral nutrition is associated with lower mortality in critically ill children. JPEN J Parenter Enteral Nutr 2014; 38 (04) 459-466
- 22 Mehta NM, Skillman HE, Irving SY. et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatr Crit Care Med 2017; 18 (07) 675-715
- 23 Fivez T, Kerklaan D, Mesotten D, Verbruggen S, Joosten K, Van den Berghe G. Evidence for the use of parenteral nutrition in the pediatric intensive care unit. Clin Nutr 2017; 36 (01) 218-223
- 24 Ziegler TR. Parenteral nutrition in the critically ill patient. N Engl J Med 2009; 361 (11) 1088-1097
- 25 Bolcato M, Russo M, Donadello D, Rodriguez D, Aprile A. Disabling outcomes after peripheral vascular catheter insertion in a newborn patient: a case of medical liability?. Am J Case Rep 2017; 18: 1126-1129
- 26 Kudsk KA, Stone JM, Carpenter G, Sheldon GF. Enteral and parenteral feeding influences mortality after hemoglobin-E. coli peritonitis in normal rats. J Trauma 1983; 23 (07) 605-609
- 27 Li J, Kudsk KA, Gocinski B, Dent D, Glezer J, Langkamp-Henken B. Effects of parenteral and enteral nutrition on gut-associated lymphoid tissue. J Trauma 1995; 39 (01) 44-51 , discussion 51–52
- 28 Fukatsu K, Zarzaur BL, Johnson CD, Lundberg AH, Wilcox HG, Kudsk KA. Enteral nutrition prevents remote organ injury and death after a gut ischemic insult. Ann Surg 2001; 233 (05) 660-668
- 29 Ikeda S, Kudsk KA, Fukatsu K. et al. Enteral feeding preserves mucosal immunity despite in vivo MAdCAM-1 blockade of lymphocyte homing. Ann Surg 2003; 237 (05) 677-685 , discussion 685
- 30 Preiser J-C, van Zanten ARH, Berger MM. et al. Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit Care 2015; 19 (01) 35
- 31 Panchal AK, Manzi J, Connolly S. et al. Safety of enteral feedings in critically ill children receiving vasoactive agents. JPEN J Parenter Enteral Nutr 2016; 40 (02) 236-241
- 32 Fuentes Padilla P, Martínez G, Vernooij RW, Urrútia G, Roqué I Figuls M, Bonfill Cosp X. Early enteral nutrition (within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults. Cochrane Database Syst Rev 2019;2019(10):
- 33 Baǧci S, Keleş E, Girgin F. et al. Early initiated feeding versus early reached target enteral nutrition in critically ill children: An observational study in paediatric intensive care units in Turkey. J Paediatr Child Health 2018; 54 (05) 480-486
- 34 King W, Petrillo T, Pettignano R. Enteral nutrition and cardiovascular medications in the pediatric intensive care unit. JPEN J Parenter Enteral Nutr 2004; 28 (05) 334-338
- 35 Tume LN, Valla FV. A review of feeding intolerance in critically ill children. Eur J Pediatr 2018; 177 (11) 1675-1683
- 36 Tume LN, Woolfall K, Arch B. et al. Routine gastric residual volume measurement to guide enteral feeding in mechanically ventilated infants and children: the GASTRIC feasibility study. Health Technol Assess 2020; 24 (23) 1-120
- 37 Wong JJ, Ong C, Han WM, Lee JH. Protocol-driven enteral nutrition in critically ill children: a systematic review. JPEN J Parenter Enteral Nutr 2014; 38 (01) 29-39
- 38 Sng QW, Ong C, Ang SLL, Kirk AHP, Lee JH. Use of an electronic feeds calorie calculator in the pediatric intensive care unit. Pediatr Qual Saf 2020; 5 (01) e249
- 39 Wong JJ, Ho SX, Lee AOC. et al. Positive fluid balance is associated with poor clinical outcomes in paediatric severe sepsis and septic shock. Ann Acad Med Singapore 2019; 48 (09) 290-297