Revista da Associação Médica Brasileira (English Edition) Revista da Associação Médica Brasileira (English Edition)
Rev Assoc Med Bras. 2013;59:563-70 - Vol. 59 Num.06

Impact of early enteral nutrition therapy on morbimortality reduction in a Pediatric Intensive Care Unit: A systematic review

Fernanda Marchetto da Silva a, Ana Carolina Gouvea Bermudes b, Ivie Reis Maneschy c, Graziela de Araújo Costa Zanatta b, Rubens Feferbaum d, Werther Brunow de Carvalho d, Uenis Tannuri e, Artur Figueiredo Delgado f

a Ambulatory of Specialties, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. Departament of Pediatrics, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
b Departament of Pediatrics, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. Pediatric Intensive Care Unit, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
c Departament of Pediatrics, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
d Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
e Discipline of Pediatric Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
f Post-graduation Program in Pediatrics, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Keywords

Critical care. Nutritional therapy. Malnutrition. Child mortality.

Abstract

Objective: To assess the impact of early introduction of enteral nutrition therapy on morbidity and mortality reduction in a pediatric intensive care unit.

Methods: A search was performed in the literature of the last 10 years in English, with the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the PubMed, Lilacs and Embase databases using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition.

Results: Despite advances in the quality of clinical care, the prevalence of malnutrition in hospitalized children remains unchanged in the last 20 years (15-30%) and has implications for the time of admission, course of illness and morbidity. Malnutrition is common and is often poorly recognized and therefore, untreated. Nutritional therapy is an essential part in the treatment of severely ill pediatric patients who have hypercatabolic protein state, which can be minimized with an effective nutritional treatment plan. In this study, we reviewed publications which have shown that there is still a paucity of randomized and controlled studies with good statistical treatment in relation to enteral nutritional therapy with outcomes related to morbidity and mortality. The current guidelines for nutritional therapy in these patients are largely based on expert opinion and data extrapolated from adult studies and studies in healthy children.

Conclusion: The scientific evidence on the use of enteral nutrition therapy in improving the development of critically ill pediatric patients is still scarce and further studies are needed focusing on it, and better guidelines must be formulated.

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