Review of outcomes used in nutritional trials in Pediatric Critical Care

Ghandvi, K; Valla, F; Tume, LN

Abstract

Background: Generating robust evidence within Pediatric Intensive Care (PIC) can be challenging because of low patient numbers and patient heterogeneity. Systematic reviews may overcome small study biases but are limited by lack of standardisation in outcome measures and their definition. Trials of nutritional interventions in PIC are increasing, thus we wanted to examine the outcome measures being used in these trials.
Objective: To systematically describe outcome measures used when a nutritional intervention has been evaluated in a PIC randomized controlled trial.
Methods: A systematic literature review of all studies involving a PIC trial of a nutritional intervention was undertaken from 1 January 1996 until 20 February 2018.
Results: Thirty-one trials met the criteria and were reviewed. They included a total of 3346 patients across all trials. Thirty-nine primary outcomes and 93 secondary outcomes were found. These were categorized into PIC-related outcomes (infection, intensive care dependency, organ dysfunction / long-term functional and mortality) and nutritional outcomes (energy targets, nutritional parameters and feeding tolerance). We found large variation in the outcome measures used. Outcome domains of energy targets, feeding tolerance and infection were not adequately defined.
Conclusions: Large variations in the outcome measures chosen and their definitions exist within PIC nutritional trials. Optimal nutritional outcomes for PIC must be agreed and defined, specifically domains of nutrition efficiency, nutrition tolerance and non-nutritional PIC outcomes. The next step is to conduct an International Delphi study to gain expert consensus and develop a core outcome set to be reported in future pediatric nutrition trials.

Citation

Ghandvi, K., Valla, F., & Tume, L. (2020). Review of outcomes used in nutritional trials in Pediatric Critical Care. Journal of Parenteral and Enteral Nutrition, 44(7), 1210-1219. https://doi.org/10.1002/jpen.1765

• Journal Article Type: Article
• Acceptance Date: Dec 4, 2019
• Online Publication Date: Feb 3, 2020
• Publication Date: Sep 17, 2020
• Deposit Date: Dec 5, 2019
• Publicly Available Date: Feb 3, 2021
• Journal: Journal of Parenteral and Enteral Nutrition
• Print ISSN: 0148-6071
• Electronic ISSN: 1941-2444
• Publisher: SAGE Publications
• Volume: 44
• Issue: 7
• Pages: 1210-1219
• DOI: https://doi.org/10.1002/jpen.1765
• Publisher URL: https://doi.org/10.1002/jpen.1765
• Related Public URLs: https://onlinelibrary.wiley.com/journal/19412444
• Additional Information: Access Information : This is the peer reviewed version of the following article: Gadhvi, K.R., Valla, F.V. and Tume, L.N. (2020), Review of Outcomes Used in Nutrition Trials in Pediatric Critical Care. Journal of Parenteral and Enteral Nutrition, 44: 1210-1219, which has been published in final form at https://doi.org/10.1002/jpen.1765. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.