Nutritional Support of Critically ill Neonates in Post-Gastrointestinal Surgery State: Adequacy and Barriers

Document Type : Original Article

Authors

1 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Social Determinants of Health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: The optimum nutritional support of critically ill neonates is considered an essential aspect of their medical management since they are susceptible to rapid nutritional depletion, loss of fat-free mass, organ failure, delayed wound healing, and diminished immune function in the post-gastrointestinal surgery state. Providing appropriate nutritional support for these high-risk patients is a very complex and critical process accompanied by many potential errors. To the best of our knowledge, this study has been the first attempt investigating the energy and protein adequacy and probable barriers to the achievement of nutritional goals in such patients.
Methods: The present study was carried out at Akbar Children’s Hospital in Mashhad, Khorasan Razavi province, Iran, during 8 months in 2019. All the gastrointestinal surgical patients admitted to the neonatal intensive care unit (NICU) for at least 72 h were eligible for enrollment in the study. The information on age, gender, primary surgical diagnosis, route of nutritional support, adequacy of received energy and protein, probable barriers to the achievement of nutritional goals, and clinical outcomes were collected in this study.
Results: Totally, 59 eligible neonates were included in the study 59.3% (n=35) of whom were male. Among different methods of nutritional support, enteral nutrition (47.5%) was the most frequently used feeding route. Energy and protein adequacy was observed in 35.5% and 79.7% of the patients, respectively. The fluid restriction was the major barrier to the provision of optimum nutritional support, affecting 38.9% of the patients. Finally, nutritional adequacy was observed to be significantly associated with decreased infection rate and length of hospital stay.
Conclusion: While 64.5% of the studied neonates did not receive adequate energy, almost 80% of them had adequate protein intake during their post-gastrointestinal surgery state. The awareness of the fluid restriction and non-availability of calorie-dense solutions as the most frequent barriers to the achievement of nutritional goals may lead to making reasonable and realistic decisions on the customized protocols of the NICU patients as well as medical management and insurance coverage of required nutritional products.

Keywords


1. Asoba GN, Sumbele IU, Anchang-Kimbi JK, Metuge S, Teh RN. Influence of infant feeding practices on the occurrence of malnutrition, malaria and anaemia in children≤ 5 years in the Mount Cameroon area: a cross sectional study. PloS One. 2019; 14(7): e0219386.
2. Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: a prospective cohort study. Clin Nutr. 2016; 35(1):144-52.
3. de Souza Menezes F, Leite HP, Koch Nogueira PC. Malnutrition as an independent predictor of clinical outcome in critically ill children. Nutrition. 2012; 28(3):267-70.
4. Mehta NM, Bechard LJ, Cahill N, Wang M, Day A, Duggan CP, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children--an international multicenter cohort study. Crit Care Med. 2012; 40(7):2204-11.
5. Cloherty JP, Eichenwald EC, Stark AR. Manual of nutrition care. Philadelphia: Lippincott Williams and Wilkins; 2008.
6. Pollack MM, Wiley JS, Holbrook PR. Early nutritional depletion in critically ill children. Crit Care Med. 1981; 9(8):580-3.
7. Cunningham JJ. Body composition and nutrition support in pediatrics: what to defend and how soon to begin. Nutr Clin Pract. 1995; 10(5):177-82.
8. Barton RG. Invited review: nutrition support in critical illness. Nutr Clin Pract. 1994; 9(4):127-39.
9. Kelleher DK, Laussen P, Teixeira-Pinto A, Duggan C. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition. 2006; 22(3):237-44.
10. Wolovits JS, Torzone A. Feeding and nutritional challenges in infants with single ventricle physiology. Curr Opin Pediatr. 2012; 24(3):295-300.
11. Griffin IJ, Domellöf M, Bhatia J, Anderson DM, Kler N. Zinc and copper requirements in preterm infants: an examination of the current literature. Early Hum Dev. 2013; 89(Suppl 2):S29-34.
12. Fernández-Menéndez S, Fernández-Sánchez ML, Fernández-Colomer B, Rafael R, Cotallo GD, Freire AS, et al. Total zinc quantification by inductively coupled plasma-mass spectrometry and its speciation by size exclusion chromatography–inductively coupled plasma-mass spectrometry in human milk and commercial formulas: importance in infant nutrition. J Chromatography A. 2016; 1428:246-54.
13. Matus BA, Bridges KM, Logomarsino JV. Evaluation of key factors impacting feeding safety in the neonatal intensive care unit: a systematic review. Adv Neonatal Care. 2019; 19(1):11-20.
14. Groh‐Wargo S, Sapsford A. Enteral nutrition support of the preterm infant in the neonatal intensive care unit. Nutr Clin Pract. 2009; 24(3):363-76.
15. Liu J, Kong K, Tao Y, Cai W. Optimal timing for introducing enteral nutrition in the neonatal intensive care unit. Asia Pac J Clin Nutr. 2015; 24(2):219-26.
16. Colomb V, Dabbas-Tyan M, Taupin P, Talbotec C, Révillon Y, Jan D, et al. Long-term outcome of children receiving home parenteral nutrition: a 20-year single-center experience in 302 patients. J Pediatr Gastroenterol Nutr. 2007; 44(3):347-53.
17. Joffe A, Anton N, Lequier L, Vandermeer B, Tjosvold L, Larsen B, et al. Nutritional support for critically ill children. Cochrane Database Syst Rev. 2016; 5:CD005144.
18. Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The nutritional and metabolic working group of the spanish society of intensive care medicine and coronary units. Crit Care Med. 1999; 27(8):1447-53.
19. Adam S, Batson S. A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK. Intensive Care Med. 1997; 23(3):261-6.
20. Rogers EJ, Gilbertson HR, Heine RG, Henning R. Barriers to adequate nutrition in critically ill children. Nutrition. 2003; 19(10):865-8.
21. Joosten K, Embleton N, Yan W, Senterre T, Braegger C. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: energy. Clin Nutr.
2018; 37(6):2309-14.
22. Mehta NM, Compher C; A.S.P.E.N. Board of Directors. Clinical guidelines: nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr. 2009; 33(3):260-76.
23. López-Herce JC. Nutrition in the critically ill child. Barcelona, Spain: Anales de Pediatria; 2009.
24. Ramel SE, Brown LD, Georgieff MK. The impact of neonatal illness on nutritional requirements: one size does not fit all. Curr Pediatr Rep. 2014; 2(4):248-54.
25. Hulst J, Joosten K, Zimmermann L, Hop W, van Buuren S, Büller H, et al. Malnutrition in critically ill children: from admission to 6 months after discharge. Clin Nutr. 2004; 23(2):223-32.
26. Skillman HE, Mehta NM. Nutrition therapy in the critically ill child. Curr Opin Crit Care. 2012; 18(2):192-8.
27. Wong JJ, 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(6):1007-13.
28. Kyle UG, Akcan-Arikan A, Orellana RA, Coss-Bu JA. Nutrition support among critically ill children with AKI. Clin J Am Soc Nephrol. 2013; 8(4):568-74.
29. Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR,
Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care. 2014; 18(6):701.
30. Hulst JM, Joosten KF, Tibboel D, van Goudoever JB. Causes and consequences of inadequate substrate supply to pediatric ICU patients. Curr Opin Clin Nutr Metab Care. 2006; 9(3):297-303.
31. de Neef M, Geukers VG, Dral A, Lindeboom R, Sauerwein HP, Bos AP. Nutritional goals, prescription and delivery in a pediatric intensive care unit. Clin Nutr. 2008; 27(1):65-71.
32. Mehta NM, Bechard LJ, Zurakowski D, Duggan CP, Heyland DK. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. Am J Clin Nutr. 2015; 102(1):199-206.
33. Boskabadi H, Maamouri G, Akhodian J, Zakerihamidi M, Sayedi SJ, Ghazvini K, et al. Neonatal Infections: a 5-year analysis in a neonatal care unit in north east of Iran. Int J Pediatr. 2016; 4(12):3989-98.
34. Leong AY, Field CJ, Larsen BM. Nutrition support of the postoperative cardiac surgery child. Nutr Clin Pract. 2013; 28(5):572-9.
Volume 11, Issue 4
October 2020
Pages 57-63