Study questions infant intensive care feeding policies

By Annie Harrison-Dunn contact

- Last updated on GMT

Researchers expect the results to transform worldwide paediatric standards of intensive care. © iStock.com / vinnstock
Researchers expect the results to transform worldwide paediatric standards of intensive care. © iStock.com / vinnstock

Related tags: Nutrition

A study of 1440 critically ill children has questioned the benefit of early parenteral nutrition in hospitals.

It is often often not possible to feed critically ill children normally via the mouth and this leads to pronounced macronutrient deficit in just a few days, which is associated with increased infections and delayed recovery.

Current guidelines – based largely on small studies and expert opinions – advises pediatric care providers to administer enteral tube feeding or parenteral intravenous drips as soon as a child is admitted to hospital to prevent this.

However the results of a clinical trial published in the New England Journal of Medicine​ has questioned this practice.

“In critically ill children, withholding parenteral nutrition for one week in the ICU was clinically superior to providing early parenteral nutrition,”​ wrote the researchers from  the University Hospitals Leuven in Belgium, Sophia Children’s Hospital Rotterdam in the Netherlands and Stollery Children’s Hospital Edmonton in Canada.

Lead author of the study Professor Greet Van den Berghe said the results provided evidence that the current common practice of feeding children with parenteral drips early does not contribute to their recovery.

“On the contrary, the children who had built up a nutritional deficiency after receiving little to no feedings had fewer infections, less organ failure, and a quicker recovery than children who had been fed through the IV. The effect was present in everyone, regardless of the type of disease, the children’s age, or the hospital in which they were staying.”

She said the results were likely to transform worldwide paediatric standards of intensive care.

The study and its patients

The trial saw 723 children given early parenteral IV nutrition within 24 hours of admission to an intensive care unit (ICU). Another 717 patients received late parenteral nutrition on the morning of the 8th day in intensive care.

In both groups, enteral oral nutrition was attempted early and intravenous micronutrients were provided.

Mortality rates were similar across the two groups, but the percentage of patients with a new infection was 10.7% in the late parenteral group compared to 18.5% in the early parenteral group.

The average duration of stay in intensive care was also about three days higher in the early group.

Late nutrition was associated with a shorter duration of mechanical ventilatory support than early nutrition as well as a smaller proportion of patients receiving renal-replacement therapy and a shorter duration of hospital stay overall.

“The underlying mechanisms of the clinical benefits observed when there is a substantial macronutrient deficit early in critical illness in children remain speculative," ​the researchers wrote. 

“Preservation of autophagy may play a role, given its importance for innate immunity and for quality control in cells with a long half-life, such as myofibers.”

Autophagy refers to an intracellular degradation system that - through a regulated process - disassembles unnecessary or dysfunctional cellular components.

Earlier studies conducted by Professor Van den Berghe and her team have also questioned the use of early artificial feeding in treatment of adults in intensive care.

Source: New England Journal of Medicine

0:0, DOI: 10.1056/NEJMoa1514762

“Early versus Late Parenteral Nutrition in Critically Ill Children”

Authors: T. Fivez, D. Kerklaan et al.  

Related topics: Research

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