Malnutrition, nutritional indices, and early enteral feeding in criticallyill children

We measured the incidences of protein and fat depletions and the frequencie s of acute and chronic protein-energy malnutrition during stress states in children and investigated the influence of early enteral feeding on nutriti on indices and acute-phase proteins. Seventy-one, consecutively enrolled, c ritically ill children received early enteral feeding (energy intakes equal to 0.50, 1, 1.25, 1.5, and 1.5 of the predicted basal metabolic rates on d ays 1 through 5, respectively) Through nasogastric tubes. On the first day of the study, 16.7% of the patients already were depleted of protein and 31 % of fat stores. Overall, 16.9% were at risk for chronic protein-energy mal nutrition and 21.1% for acute protein-energy malnutrition, whereas 4.2% and 5.6% already had chronic and acute, respectively protein-energy malnutriti on. Only 22.7% of patients without protein deficiencies versus 37% of those at risk or already deficient developed multiple-organ system failure. Tran sferrin and prealbumin levels improved at the end of the period of early en teral feeding (187 +/- 6.6 versus 233 +/- 7 mg/dL, P < 0.0001; 15.1 +/- 2 v ersus 21.9 +/- 2.9 mg/dL, P < 0.0001; respectively); survivors had higher p realbumin levels than non-survivors (22.3 versus 15.5 mg/dL). With logistic regression analysis, only repleted energy, not anthropometric or nutrition indices, was independently associated with survival (P = 0.05). These resu lts reinforce the observation that critically ill children are at risk for fat or protein depletion and development of malnutrition, which is associat ed with increased morbidity and mortality. We conclude that early enteral n utrition improves nutrition indices and outcomes. (C) Elsevier Science Inc. 2001.