Skeletal Muscle Ultrasonography in Nutrition and Functional Outcome Assessment of Critically Ill Children: Experience and Insights From Pediatric Disease and Adult Critical Care Studies

This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form atOng, C. , Lee, J. H., Leow, M. K. and Puthucheary, Z. A. (2017), Skeletal Muscle Ultrasonography in Nutrition and Functional Outcome Assessment of Critically Ill Children: Experience and Insights From Pediatric Disease and Adult Critical Care Studies. Journal of Parenteral and Enteral Nutrition, 41: 1091-1099. doi:10.1177/0148607116683143. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Version

BODY MASS, COMPOSITION AND FUNCTIONAL OUTCOMES IN CRITICALLY ILL CHILDREN

Ph.DDOCTOR OF PHILOSOPHY (SOM

Evidence for Low Residue Diet in the Management of Gastrointestinal Related Conditions

The low residue diet is commonly recommended for pre-colonoscopy bowel preparation as well as in the management of some gastrointestinal conditions including inflammatory bowel disease. There is no objective measurement for residue, resulting in poor standardisation of a low residue diet. This review examines the efficacy of a low residue diet in the management of gastrointestinal conditions. A literature search was conducted in Medline and the Cochrane Library, and eight randomised controlled trials with human subjects met the inclusion criteria. Six studied the low residue diet for pre-colonoscopy bowel preparation, the other two were conducted in Crohn's disease and post-gynaecological surgery, respectively. The low residue diet was comparable to the clear liquid diet for bowel preparation without increased side-effects. Post-gynaecological surgery, early feeding using low residue diet decreased nausea without increasing gastrointestinal symptoms when compared to the traditional feeding method. There was limited evidence on the advantage of a low residue diet over a normal diet in the management of acute, non-stenosing Crohn's disease. More rigorous studies are required to evaluate the efficacy of the low residue diet for the management of gastrointestinal conditions. In addition, substituting a low residue diet with a low fibre diet would be a more measurable and objective method to standardise guidelines both for research and therapy

Addressing milk kinship in milk banking: experience from Singapore's first donor human milk bank

The KK Human Milk Bank (KKHMB), the first and only human milk bank in Singapore, was established in August 2017 to provide safe pasteurised donor human milk (PDHM) to vulnerable preterm and sick infants with insufficient own mother’s milk, as the use of donor human milk (DHM) is potentially lifesaving for these infants. To promote inclusivity and equal access to DHM by all the communities in our multiracial country with a Malay population of 13.5%,[5] the concept of milk kinship in Islam, which could hinder the acceptability of PDHM in Muslim preterm infants, had to be addressed.Temasek Foundation CLG LimitedPublished versionWe thank Temasek Foundation for their generous funding and support for the setup of the Temasek Foundation Cares Donor Human Milk Bank Programme

Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

10.3389/fnut.2021.666464Frontiers in Nutrition866646

Protein supplementation versus standard feeds in underweight critically ill children : A pilot dual-centre randomised controlled trial protocol

Introduction Protein-energy malnutrition, increased catabolism and inadequate nutritional support leads to loss of lean body mass with muscle wasting and delayed recovery in critical illness. However, there remains clinical equipoise regarding the risks and benefits of protein supplementation. This pilot trial will determine the feasibility of performing a larger multicentre trial to determine if a strategy of protein supplementation in critically ill children with body mass index (BMI) z-score ≤-2 is superior to standard enteral nutrition in reducing the length of stay in the paediatric intensive care unit (PICU). Methods and analysis This is a randomised controlled trial of 70 children in two PICUs in Singapore. Children with BMI z-score ≤-2 on PICU admission, who are expected to require invasive mechanical ventilation for more than 48 hours, will be randomised (1:1 allocation) to protein supplementation of ≥1.5 g/kg/day in addition to standard nutrition, or standard nutrition alone for 7 days after enrolment or until PICU discharge, whichever is earlier. Feasibility outcomes for the trial include effective screening, satisfactory enrolment rate, timely protocol implementation (within first 72 hours) and protocol adherence. Secondary outcomes include mortality, PICU length of stay, muscle mass, anthropometric measurements and functional outcomes. Ethics and dissemination The trial protocol was approved by the institutional review board of both participating centres (Singhealth Centralised Institutional Review Board and National Healthcare Group Domain Specific Review Board) under the reference number 2020/2742. Findings of the trial will be disseminated through peer-reviewed journals and scientific conferences. Trial registration number NCT04565613.publishedVersionPeer reviewe

Changes in global nutrition practices in critically ill children and the impact of emerging evidence: a secondary analysis of the Pediatric International Nutrition Studies (PINS), 2009-2018

Background: The timeline of the three Pediatric International Nutrition Studies (PINS) coincided with the publication of 2 major guidelines for the timing of parenteral nutrition (PN) and recommended energy and protein delivery dose. Objective: The study's main objective was to describe changes in the nutrition delivery practice recorded in PINS 1 and 2 (conducted in 2009 and 2011, pre-exposure epoch) versus PINS 3 (conducted in 2018,post-exposure epoch), in relation to the published practice guidelines. Design: This study is a secondary analysis of data from a multi-center prospective cohort study. Participants: /setting. Data from 3650 participants, aged 1 month to 18 years, admitted to 100 unique hospitals that participated in three PINS was used for this study. Main outcome measures: The time in days from PICU admission to the initiation of PN and enteral nutrition (EN) delivery were the primary outcomes. Prescribed energy and protein goals were the secondary outcomes. Statistical analyses performed: A frailty model with a random intercept per hospital with stratified baseline hazard function by region for the primary outcomes and a mixed-effects negative binomial regression with random intercept per hospital for the secondary outcomes. Results: The proportion of patients receiving EN (88.3% vs. 80.6%, p-value<0.001) was higher, and those receiving PN (20.6% vs. 28.8%, p-value<0.001) was lower in the PINS3 cohort compared to PINS1-2. In the PINS3 cohort, the odds of initiating PN during the 1st 10 days of PICU admission were lower, compared to the PINS1-2 cohort (HR=0.8, CI=[0.67-0.95], p-value=0.013); and prescribed energy goal was lower compared to the PINS1-2 cohort (IRR=0.918, CI=[0.874-0.965], p=0.001). Conclusions: The likelihood of initiation of PN delivery significantly decreased in the first ten days post-admission in the PINS3 cohort compared to PINS1-2. Energy goal prescription in mechanically ventilated children significantly decreased in the post-guidelines epoch compared to the pre-guidelines epoch