Metabolic, endocrine and nutritional aspects of critically ill children

Part 1 provides the aims of the studies (chapter 1) and a general overview and discussion of the current literature of metabolic, endocrine and nutritional aspects in critically ill children (chapter 2). In Part 2 the clinical use of an indirect calorimeter is tested and validated for use in critically ill mechanically ventilated children. In chapter 3 a new indirect calorimeter is tested in a laboratory setting using a ventilated lung model and a butane burner system to determine the accuracy of the calorimeter for use in young infants and children. The influence of low tidal volumes and low levels of oxygen consumption and carbon dioxide production with different levels of inspired oxygen concentrations is investigated. [n chapter 4 it is questioned how accurately total daily energy expenditure of mechanically ventilated pediatric patients can be estimated from measurement periods . of less than 24 hours. In addition, the influence of tube leakage on energy expenditure measurements is determined. In Part 3 the clinical use of the indirect calorimeter is tested in mechanically ventilated children. In chapter 5 using indirect calorimetry the following issues were studied: 1 What are the actual energy needs are for critically ill mechanically ventilated chi

The launch of the ESPEN Special Interest Group in Paediatric Clinical Nutrition

Background & aims: At the 37th annual ESPEN congress in Lisbon, a new Special Interest Group (SIG) in Paediatric Clinical Nutrition was formed. As a first activity of this group, a survey was sent out to all ESPEN members to collect opinions about the objectives of this SIG, explore the interest of ESPEN members in paediatric related nutrition research and clinical practice and to offer to the opportunity for a wider future participation. Methods: A web-based questionnaire survey was distributed to all members of ESPEN via the regular society's newsletter. Results: In total, 123/2828 (4.3%) ESPEN members from 50 countries completed the survey. Fifty-nine of the responders were working in paediatric clinical practice and/or research, 42 in adult medicine, and 20 in both. Fifty-seven (51%) respondents agreed that there is inadequate representation of paediatric nutrition in the current ESPEN activities and 90% of all would like to see more paediatric topics at the ESPEN annual congresses. The development of paediatric clinical practice guidelines should be the scope of this SIG, as indicated by 85 (69%) respondents. Seventy-six (69%) believed that the creation of a Paediatric Clinical Nutrition SIG is likely to impact positively on the society's membership. Conclusions: There is an unmet need for more paediatric related topics and representation with the activities of the ESPEN group. The SIG in Paediatrics aspires to foster multicentre research, development of guidelines and provide a hub for interaction and knowledge exchange

Pediatric screening tools for malnutrition: an update

Purpose of review There is ongoing interest in nutritional screening tools in pediatrics to facilitate the identification of children at risk for malnutrition who need further assessment and possible nutritional intervention. The choice for a specific tool depends on various factors. This review aims to provide an overview of recent progress in pediatric nutritional screening methods. Recent findings We present recent studies about newly developed or adjusted tools, the applicability of nutritional screening tools in specific populations, and how to implement screening in the overall process of improving nutritional care in the pediatric hospital setting. Summary Three new screening tools have been developed for use on admission to hospital: two for the mixed pediatric hospitalized population and one for infants. A simple weekly rescreening tool to identify hospital-acquired nutritional deterioration was developed for use in children with prolonged hospital stay. Different from most previous studies that only assessed the relationship between the nutriti

Association between nutritional status and subjective health status in chronically ill children attending special schools

Purpose: In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the association between nutritional status and subjective health status in chronically ill children attending special schools. Methods: Overall, 642 children, median age 9.8 years (IQR 7.7–11.5), 60 % male, 72 % Caucasian, were included in this prospective study in nine special schools for chronically ill children in the Netherlands. Overall malnutrition was assessed as: acute malnutrition (<−2 SDS for weight for height (WFH)) and chronic malnutrition (<−2 SDS for height for age). The malnutrition risk was assessed with the nutritional risk-screening tool STRONGkids. Subjective health status was assessed with EQ-5D. Results: Overall, 16 % of the children had overall malnutrition: 3 % acute and 13 % chronic malnutrition. Nurses reported ‘some/severe problems’ on the health status dimensions mobility (15 %), self-care (17 %), usual activities (19 %), pain/discomfort (22 %), and anxiety/depression (22 %) in chronically ill children. Their mean visual analogue scale score (VAS) was 73.0 (SD 11.1). Malnutrition, medication usage, and younger age explained 38 % of the variance of the VAS score. Conclusions: The presence of overall malnutrition in chronically ill children attending special schools was associated with lower subjective health status, especially in younger children and in those with chronic medication usage. Therefore, it is important to develop and use profile-screening tools to identify these children

Current clinical trials in paediatrics: report of the ESPEN special interest group in paediatrics

Background &amp; aims: At the 38th annual ESPEN congress in The Hague, the Netherlands, the Special Interest Group (SIG) in Paediatrics presented data about current research activities in the field of paediatric nutrition which are performed worldwide and translated this to future research perspectives. Methods: Extensive search of all registered observational and interventional clinical trials in the database ClinicalTrials.gov using the search terms: children nutrition, paediatrics nutrition and children feeding. Results: A total of 717 studies were found; 173 were duplicates and 114 included adult participants and were therefore excluded. Hence, 430 remained for analysis, of which 69% were randomized controlled trials. The most investigated research topic was nutrition in specific diseases (n = 98), followed by obesity (n = 92), and studies including premature infants (n = 48). The overall median estimated enrolment of children in the trials was 150 children [IQR 50–365]. There were 44 studies in which &gt;1000 participants will be enrolled and six studies with &gt;10,000 participants. Studies including &gt;1000 participants were primarily performed in North America (39%), Africa (27%), and Europe (16%). Conclusions: This SIG report showed that 430 clinical nutrition trials in paediatrics are registered and current research focusses primarily on specific diseases and obesity. The SIG paediatrics encourages future research to invest in well-controlled interventional trials

One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis

Objective: To investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis. Design: Retrospective study conducted between 1997 and 2004. Setting: University-affiliated paediatric intensive care unit (PICU). Patients and participants: Sixty children admitted to the PICU with meningococcal sepsis, not treated with steroids. Interventions: Adrenal hormone concentrations were determined as soon as possible after PICU admission, and after 12 h and 24 h. To assess disease severity, PRISM score and selected laboratory parameters were determined. Measurements and main results: On admission, before blood was drawn, 23 children had been intubated with etomidate, 8 without etomidate and 29 were not intubated. Children who were intubated had significantly higher disease severity parameters than those not intubated, whereas none of these parameters significantly differed between children intubated with or without etomidate. Children who received etomidate had significantly lower cortisol, higher ACTH and higher 11-deoxycortisol levels than those who did not receive etomidate. Arterial glucose levels were significantly lower in children who were intubated with etomidate than in non-intubated children. When children were intubated with etomidate, cortisol levels were 3.2 times lower for comparable 11-deoxycortisol levels. Eight children died, seven of whom had received etomidate. Within 24 h cortisol/ACTH and cortisol/11-deoxycortisol ratios increased significantly in children who received etomidate, but not in children who did not, resulting in comparable cortisol/ACTH ratios with sti

Electrocardiographic variables in children with syndromic craniosynostosis and primary snoring to mild obstructive sleep apnea

Background: In the spectrum of children with symptomatic sleep disordered breathing (SDB), some individuals – such as those with upper airway resistance syndrome (UARS) – do not have abnormalities on polysomnography (PSG). In this study we have assessed whether assessment of respiratory arrhythmia (RA) and heart rate variability (HRV) analysis helps in management of children with syndromic craniosynostosis and none-to-mild obstructive sleep apnea (OSA). Methods: Prospective cohort study in children aged 1–18 years old with syndromic craniosynostosis. Children were selected for HRV analysis from the ECG if their obstructive apnea–hypopnea index (oAHI) was between zero and five per hour (ie, oAHI ≤5/hour). Subjects were divided into groups based on the presence or absence of respiratory arrhythmia (with or without RA respectively) using the electrocardiogram (ECG). The main analysis included studying the relationship between RA and HRV, symptoms, interventions, and sleep architecture. Results: We identified 42 patients with, at worst, mild OSA. We found higher parasympathetic control and higher total power in children with RA during the non-rapid eye movement (non-REM) sleep. Children with RA also have a relatively higher percentage of paradoxical breathing during non-REM sleep (P = 0.042). Intracranial hypertension was distributed equally between groups. Last, RA patients showed increased parasympathetic activity that further increased in non-REM sleep. Conclusion: In syndromic craniosynostosis cases with SDB and PSG showing oAHI ≤5/hour, the presence of RA may indicate subsequent need for treatment interventions, and a trend toward higher occurrence of clinical symptoms. ECG analyses of HRV variables in subjects with RA demonstrate increased parasympathetic activity and total power. Such findings may add to the diagnosis of apparently asymptomatic children

Adequate feeding and the usefulness of the respiratory quotient in critically ill children

Objective: We determined incidences of underfeeding and overfeeding in children who were admitted to a multidisciplinary tertiary pediatric intensive care and evaluated the usefulness of the respiratory quotient (RQ) obtained from indirect calorimetry to assess feeding adequacy. Methods: Children 18 y and younger who fulfilled the criteria for indirect calorimetry entered our prospective, observational study and were studied until day 14. Actual energy intake was recorded, compared with required energy intake (measured energy expenditure plus 10%), and classified as underfeeding (<90% of required), adequate feeding (90% to 110% of required), o