A significant proportion of critically ill children admitted to the paediatric intensive care unit (PICU) present with nutritional deficiencies. Undernourished hospitalised patients have a higher rate of complications, increased mortality, longer length of hospital stay, and increased hospital costs.
Critical illness may further contribute to nutritional impairment with poor outcomes. Younger age, longer duration in PICU, congenital heart disease, burn injury, and need for mechanical ventilation support are some of the factors that are associated with nutritional deficiencies.
Effective nutritional therapy in patients with burns involves an understanding of the physiological and metabolic alterations that accompany traumatic injury. Nutritional support must also accommodate for the surgical and medical needs of the patient.
It is essential to meet the patient’s nutritional needs in order to minimise the devastating effects attributed to burns injury such as loss of lean body mass and depletion of reserves. A failure to meet these needs could result in impaired wound healing, negative nitrogen balance, further weight loss and altered immune function and poor outcomes.
In burns patients nowadays it is common practice to use tube feeding combined with supplemental parenteral nutrition, the latter is used during periods of enteral intolerance, hemodynamic instability, septic episodes, or post surgery. Retrospective analyses has demonstrated that this practice is safe and effective, providing adequate energy and protein, promotion of wound healing and improving mortality.[4-6]
Pre & post surgery
In paediatric patients, surgery provokes an increased stress response which is catabolic and involves the mobilisation of energy stores as well as micronutrient losses. The response to injury is variable and depends on age, the degree of organ maturity, underlying nutritional status, and severity of the insult. Individualised, adequate nutritional support in the pre & postoperative period decreases morbidity and mortality.
Enteral tube feeding is the first choice for the nutritional management of surgical patients. If the gastrointestinal tract cannot be utilised, parenteral nutrition is indicated, e.g. in cases where enteral nutrition is not tolerated, hemodynamic instability, and active gastrointestinal bleeding.
- Mehta NM, Duggan CP. Nutritional deficiencies during critical illness. Pediatr Clin North Am 2009;56:1143-60.
- Prelack K, Dylewski M, Sheridan RL. Practical guidelines for nutritional management of burn injury and recovery. Burns 2007;33:14-24.
- The Burn Resource Centre. Paediatric Burn Nutrition. www.burnsurvivor.com.
- Prelack K, Cunningham JJ, Sheridan RL, et al. Energy and protein provisions revisited: an outcomes-based approach for determining requirements. JBCR 1997;18:177–81.
- Sheridan RL, Prelack K, Kadilak P, et al. Supplemental parenteral nutrition does not increase mortality in children. JBCR 2000;21:234S.
- Cunningham JJ, Lydon MK, Russell WE. Calorie and protein provision for recovery from severe burns in infants and young children. Am J Clin Nutr 1990;51:553–7.
- Chwals WJ. Metabolism and nutritional frontiers in pediatric surgical patients. Surg Clin North Am 1992;72:1237-66.
- DeBiasse MA, Wilmore DW. What is optimal nutritional support? New Horizons 1994; 2:122-30.