Table 14.11 Nutritional Management in Children Post ABI
Author Year Country Study Design Sample Size |
Methods | Outcomes |
Meinert et al. (2018) USA Secondary RCT Analysis N=90 |
Population: Group 1 (N=5): Age=<18yr; Gender: Male=80%, Female=20%; Mean time post injury=acute; Mean GCS=5.6 (0.5). Group 2 (N=32): Age=<18yr; Gender: Male=59.4%, Female=40.6%; Mean time post injury=acute; Mean GCS=5.5 (0.2). Group 3 (N=36): Age=<18yr; Gender: Male=72.2%, Female=27.8%; Mean time post injury=acute; Mean GCS=6 (0.2). Group 4 (N=17): Age=<18yr; Gender: Male=47.1%, Female=52.9%; Mean time post injury=acute; Mean GCS=6.3 (0.2). Intervention: Patients of a hypothermia RCT were stratified into 4 groups based on nutritional support: Group 1 had no nutritional support over the first 7 days; Group 2 had nutritional support initiated <48 hours after injury; Group 3 had nutritional support initiated between 48 and 72 hours after injury; Group 4 had nutritional support initiated 72 to 168 hours after injury. Assessed at 6m and 12m (for the GOS-E) Outcomes: mortality and Glasgow Outcomes Scale- Extended for pediatrics (GOS-E). |
1. Significant main effect of group on mortality rates (p=0.01) indicating the earlier nutritional support had reduced mortality rates. 2. Significant main effect of group on GOS-E at 6 and 12 months (p=0.03 and p=0.04, respectively) showing earlier nutritional support had higher scores. |
(2006) Greece RCT PEDro=8 N=40 |
Population: TBI; Gender: Male=29, Female=11; Time Post Injury=<12 hr. Immune Enhanced Formula (IEF; n=20): Mean Age=10.6yr; Mean GCS=6.1. Regular Formula (RF; n=20): Mean Age=9.3yr; Mean GCS=6.3. Intervention: Patients that were mechanically ventilated were randomly assigned to receive either IEF or RF via enteral feeding. Patients were fed hourly over 5 d with increases made daily from 50% of predicted basal metabolic rate to 100%, 125%, 150% and 150% again on day five. Outcome Measure: Pediatric Risk of Mortality (PRISM), Length of Stay (LOS), Length of Mechanical Ventilation, Nitrogen Balance Levels, Gastric Culture Levels. |
1. Severity of developed illnesses according to PRISM scores, LOS and length of mechanical ventilation did not differ significantly between groups (p>0.050) although IEF patients demonstrated a higher trend in illness severity. 2. Nitrogen balance was significantly higher in IEF patients after 24 hr of feeding (p<0.050) compared to RF patients. However, IEF patients did not change significantly over the course of treatment (p>0.050). 3. IEF patients exhibited significantly less gastric culture than RF patients (p<0.020) but bronchoalveolar lavage colonization and other nosocomial infections did not differ significantly between groups (p>0.050). |