Impact of the structure and dose of protein intake on clinical and metabolic outcomes in critically ill children: a systematic review

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2017-09, Vol.41, p.97-106
• Main Authors: Hauschild, Daniela B., MSc, Ventura, Julia C., MSc, Mehta, Nilesh M., MD, Moreno, Yara M.F., PhD
• Format: Article
• Language: English
• Subjects: Amino acids; Breakdowns; Child; Children; Clinical outcomes; Clinical trials; Critical Care - methods; Critical Illness; Critically ill; Dietary Proteins - administration & dosage; Dietary Proteins - metabolism; Enteral nutrition; Enteral Nutrition - methods; Gastroenterology and Hepatology; Humans; Illnesses; Intensive care; Intensive Care Units, Pediatric; Length of Stay - statistics & numerical data; Lists; Literature reviews; Mechanical ventilation; Medical research; Metabolism; Mortality; Nitrogen; Nitrogen balance; Nutrition; Parenteral nutrition; Patients; Pediatric intensive care unit; Pediatrics; Protein; Protein sources; Protein structure; Proteins; Respiration, Artificial - statistics & numerical data; Systematic review; Ventilation; Ventilators
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2017.04.013

Abstract Objective The aim was to describe the impact of structure/type and total amount of protein intake on protein balance and clinical outcomes in critically ill children. Research Methods & Procedures Systematic review of relevant literature on Embase, PubMed/Medline, Web of Science, Scopus and Latin American and Caribbean Health Sciences. A partial gray literature search was undertaken and the reference lists of the selected articles were searched manually. Observational and clinical trials that evaluated the total protein intake and/or structure of the protein source in critically ill children were included. Nitrogen balance and clinical outcomes (mortality, length of stay, duration of mechanical ventilation) were the main outcomes of interest. Results We found 18 eligible studies, 17 assessed the quantity and 1 study described protein structure in relation to the outcomes. In total, 2118 pediatric critically ill patients less than 18 years of age were included. The total protein intake ranged from 0.67 to 4.7 g/kg/day. Average daily total protein intake greater than 1.1 g/kg/day, specially above 1.5 g/kg/day, was associated with positive protein balance and with lower mortality. Conclusion In critically ill children, total protein intake above 1.1 g/kg/day was associated with positive impact on clinical outcomes and protein balance. There are insufficient data to determine the optimal structure of protein delivered by enteral route in critically ill children.