Chinese guidelines for the assessment and provision of nutrition support therapy in critically ill children
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This document represents the first evidence-based guidelines to describe best practices in nutrition therapy in critically ill children (> 1 month and < 18 years), who are expected to require a length of stay more than 2 or 3 days in a Pediatric Intensive Care Unit admitting medical patients domain.
A total of 25,673 articles were scanned for relevance. After careful review, 88 studies appeared to answer the pre-identified questions for the guidelines. We used the grading of recommendations, assessment, development and evaluation criteria to adjust the evidence grade based on the quality of design and execution of each study.
The guidelines emphasise the importance of nutritional assessment, particularly the detection of malnourished patients. Indirect calorimetry (IC) is recommended to estimate energy expenditure and there is a creative value in energy expenditure, 50 kcal/kg/day for children aged 1–8 years during acute phase if IC is unfeasible. Enteral nutrition (EN) and early enteral nutrition remain the preferred routes for nutrient delivery. A minimum protein intake of 1.5 g/kg/day is suggested for this patient population. The role of supplemental parenteral nutrition (PN) has been highlighted in patients with low nutritional risk, and a delayed approach appears to be beneficial in this group of patients. Immune-enhancing cannot be currently recommended neither in EN nor PN.
Overall, the pediatric critically ill population is heterogeneous, and an individualized nutrition support with the aim of improving clinical outcomes is necessary and important.
KeywordsAdolescents Children Critical illness Enteral nutrition Indirect calorimetry Infant Malnutrition Nutrition assessment Parenteral nutrition Pediatric Resting energy expenditure
All authors contributed equally to this paper.
This study was funded in total by internal funds from the Emergency group of Chinese Pediatrics Society and Pediatrics Group of Chinese Emergency Society, both of which are affiliated to the Chinese Medical Association.
Compliance with ethical standards
Not required for this Guideline.
Conflict of interest
No financial interests have been received directly or indirectly related to the subject of this article. The guidelines are intended for general information only, and do not replace professional medical care and physician advice, which always should be sought for any medical condition.
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