Premium
Protocol‐Driven Enteral Nutrition in Critically Ill Children
Author(s) -
Wong Judith JuMing,
Ong Chengsi,
Han Wee Meng,
Lee Jan Hau
Publication year - 2014
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607113502811
Subject(s) - medicine , cinahl , observational study , randomized controlled trial , intensive care medicine , medline , parenteral nutrition , protocol (science) , enteral administration , pediatrics , mechanical ventilation , psychological intervention , cohort study , cochrane library , pediatric intensive care unit , emergency medicine , alternative medicine , nursing , pathology , political science , law
Enteral nutrition (EN) protocols are thought to improve clinical outcomes in the pediatric intensive care unit (PICU); however, critical evaluation of their efficacy is limited. We conducted a systematic review with the aim of assessing the effect of EN protocols on important clinical outcomes in these children. We searched MEDLINE, Cochrane Database for Reviews, Embase, and CINAHL using predetermined keywords and MESH terms. We included randomized controlled trials (RCTs) and observational studies that involved EN protocols in children admitted to the PICU for >24 hours. We included studies that reported at least 1 of our outcomes of interest. Studies that exclusively studied premature neonates or adults were excluded. Primary outcomes were PICU or hospital mortality, PICU or hospital length of stay (LOS), duration of mechanical ventilation, gastrointestinal (GI) complications, and infective complications. Secondary outcomes were time to initiate feeds and time to achieve goal feeds. In total, we included 9 studies (total 1564 children) in our systematic review (1 RCT, 4 before‐and‐after studies, 1 single‐arm cohort study, 1 prospective descriptive study, and 2 audits). There is low‐level evidence that the use of EN protocols is associated with a reduction in GI and infective complications and improved timeliness of feed initiation and achievement of goal feeds. Current medical literature does not have compelling data on the effects of an EN protocol on clinical outcomes among critically ill children. Future clinical trials should look into using standardized interventions and outcome measures to strengthen the existing evidence.