Nutritional support for children during critical illness : European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

Tume, LN; Valla, F; Joosten, K; Jotterand-Chaparro, C; Latten, L; Marino, L; McCloud, I; Moullet, C; Pathan, N; Rooze, S; Van Rosmalen, J; Verbruggen, S

Abstract

Background: Nutritional support is considered essential for the outcome of pediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the pediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines.

Objective: To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children.

Design: The Metabolism, Endocrine and Nutrition (MEN) section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (>95% agreement) and consensus (>75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds.

Results: The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions.

Conclusions: We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the pediatric critical care clinicians around important clinical questions.

Citation

Tume, L., Valla, F., Joosten, K., Jotterand-Chaparro, C., Latten, L., Marino, L., …Verbruggen, S. (2020). Nutritional support for children during critical illness : European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Medicine, 46, 411-425. https://doi.org/10.1007/s00134-019-05922-5

• Journal Article Type: Article
• Acceptance Date: Dec 28, 2019
• Online Publication Date: Feb 20, 2020
• Publication Date: Mar 1, 2020
• Deposit Date: Jan 21, 2020
• Publicly Available Date: Mar 2, 2020
• Journal: Intensive Care Medicine
• Print ISSN: 0342-4642
• Electronic ISSN: 1432-1238
• Publisher: Springer Verlag
• Volume: 46
• Pages: 411-425
• DOI: https://doi.org/10.1007/s00134-019-05922-5
• Publisher URL: https://doi.org/10.1007/s00134-019-05922-5
• Related Public URLs: https://link.springer.com/journal/134
• Additional Information: Corporate Creators : European Society of Pediatric & Neonatal Intensive Care; Funders : Nutricia Advanced Medical Nutrition;National Institute for Health Research; Projects : Health Education England/NIHR Clinical Lectureship; Grant Number: ICA-CL-2016-02-001