Actualización en el soporte nutricional del paciente pediátrico críticamente enfermo

• Published in: Acta pediátrica española Vol. 75; no. 7/8; pp. E117 - E123
• Main Authors: Galera-Martínez, R, López-Ruzafa, E, López, A Moráis, More, RA Lama
• Format: Journal Article
• Language: Spanish
• Published: Madrid Ediciones Mayo 01.07.2017
• Subjects: Childrens health; Critical care; Nutrition; Pediatrics
• ISSN: 0001-6640; 2014-2986

Paediatric critically ill (CI) patients are characterised by a high nutritional risk, due to the hyper-catabolism and the inflammatory state secondary to the stress response to critical illness in the acute phase. Malnutrition prevalence in these patients remains high and it is associated to a higher mortality rate. In addition, both malnutrition and obesity are associated with a worse clinical evolution. Nutritional support (NS) should focus not only in the achievement of an adequate nutritional status, moreover it can also modulate the metabolic, neuro-endocrine and inflammatory response, optimizing the benefits of this response in the short term and reducing the adverse outcomes in the medium and long term. Despite the importance of NS in the paediatric CI patient, the evidence available is scare, so international consensus-based guidelines mostly rely on expert opinion, studies in adults or non-critically ill children. Nevertheless, during recent years several studies have provided more data regarding NS in these patients; to adjust the energy provided depending of the illness phase, to avoid overfeeding and hyperglycaemia, the choice of appropriate route of feeding, the necessity of overcoming several barriers to start enteral nutrition and its importance in the CI patient or the timing to initiate parental nutrition, are topics that will be covered in this review.