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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.

Briassoulis et al.

(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).