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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

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
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
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.
Child, Enteral nutrition, Guidelines, Intensive care, Paediatric, Parenteral nutrition
1529-7535
411-425
Hughes, Lyvonne
1d0a039a-ac0d-4a6c-b4d2-6dc8f774c56c
Valla, Frederic V.
5aaabcab-c5d9-4da4-9cae-2a8b67ac74a3
Joosten, Koen F.M.
abe9b92c-7e88-4c4c-ba48-411548953ea2
Jotterand Chaparro, Corinne
d1e93b86-eb63-4c31-9424-618cd1482512
Latten, Lynne
6ca915c1-d8f6-401d-a332-8cd725dbff99
Marino, Luise
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Macleod, Isobel
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Moullet, Clemence
fe15a892-0a5d-4af9-a51a-22b1eceb9a26
Pathan, Nazima
4d1ef72a-afc0-4082-b6e0-41fb84c64154
Rooze, Shancy
2981299a-21ac-4954-802b-c561f7eca489
van Rosmalen, Joost
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Verbruggen, Sascha C.A.T.
f49e7802-0a44-406b-8d3d-c9d31a941038
Hughes, Lyvonne
1d0a039a-ac0d-4a6c-b4d2-6dc8f774c56c
Valla, Frederic V.
5aaabcab-c5d9-4da4-9cae-2a8b67ac74a3
Joosten, Koen F.M.
abe9b92c-7e88-4c4c-ba48-411548953ea2
Jotterand Chaparro, Corinne
d1e93b86-eb63-4c31-9424-618cd1482512
Latten, Lynne
6ca915c1-d8f6-401d-a332-8cd725dbff99
Marino, Luise
c479400f-9424-4879-9ca6-d81e6351de26
Macleod, Isobel
faeba8fa-c966-45d6-abd8-274715509251
Moullet, Clemence
fe15a892-0a5d-4af9-a51a-22b1eceb9a26
Pathan, Nazima
4d1ef72a-afc0-4082-b6e0-41fb84c64154
Rooze, Shancy
2981299a-21ac-4954-802b-c561f7eca489
van Rosmalen, Joost
8bd5b6c6-7340-42b9-8f05-ea9d7df1ed7e
Verbruggen, Sascha C.A.T.
f49e7802-0a44-406b-8d3d-c9d31a941038

Hughes, Lyvonne, Valla, Frederic V., Joosten, Koen F.M., Jotterand Chaparro, Corinne, Latten, Lynne, Marino, Luise, Macleod, Isobel, Moullet, Clemence, Pathan, Nazima, Rooze, Shancy, van Rosmalen, Joost and Verbruggen, Sascha C.A.T. (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. Pediatric Critical Care Medicine, 46 (3), 411-425. (doi:10.1007/s00134-019-05922-5).

Record type: Article

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.

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Accepted/In Press date: 28 December 2019
Published date: 1 March 2020
Additional Information: Funding Information: The authors of these guidelines have reported all potential conflicts or financial disclosures. For a complete overview of the potential conflicts and financial disclosures see below. No funding or contribution from industry was involved in the completion of these recommendations, nor were any industry representatives present at any of the committee meetings. LNT is a member of the NIHR. SCV is supported by Nutricia Advanced Medical Nutrition (unrestricted research grant). SCV has received speakers’ fees from Nutricia Advanced Medical Nutrition and Baxter in the past. KJ is supported by Nutricia Advanced Medical Nutrition (unrestricted research grant). FVV has received speaker fees from Fresenius Kabi and Nutricia (past) and consultant fees from Baxter (current). LVM is supported by a Health Education England/NIHR Clinical Lectureship (ICA-CL-2016-02-001) supported by the National Institute for Health Research. LVM has also received speaker’s fees from Abbott Laboratories and Nutricia in the past. NP is supported by research funding from the National Institute for Health Research. CJC is supported by the Marisa Sophie Foundation and has received travel fees from Nutricia and Baxter (past). CM is supported by the Marisa Sophie Foundation and has received travel fees from Nutricia and Baxter (past). Publisher Copyright: © 2020, The Author(s).
Keywords: Child, Enteral nutrition, Guidelines, Intensive care, Paediatric, Parenteral nutrition

Identifiers

Local EPrints ID: 436956
URI: http://eprints.soton.ac.uk/id/eprint/436956
DOI: doi:10.1007/s00134-019-05922-5
ISSN: 1529-7535
PURE UUID: 9e705392-75a3-45ac-8166-e8929c8dfe98

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Date deposited: 14 Jan 2020 17:32
Last modified: 17 Mar 2024 05:12

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Contributors

Author: Lyvonne Hughes
Author: Frederic V. Valla
Author: Koen F.M. Joosten
Author: Corinne Jotterand Chaparro
Author: Lynne Latten
Author: Luise Marino
Author: Isobel Macleod
Author: Clemence Moullet
Author: Nazima Pathan
Author: Shancy Rooze
Author: Joost van Rosmalen
Author: Sascha C.A.T. Verbruggen

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