When a child is hospitalized in critical condition, optimal delivery of nutritional support plays a vital role in the outcome. Unfortunately, no solid data exists regarding the best way to feed critically ill children.
"There are important gaps in knowledge regarding timing, route, dose and type of nutritional support needed for critically ill infants and children," said Dr. Katri Typpo, assistant professor in the department of pediatrics and a researcher with the University of Arizona Steele Children's Research Center.
A new Steele Center research project aims to bridge that gap, with the first randomized trial of IV nutrition (known as TPN, or total parenteral nutrition) for pediatric critical illness.
Typpo recently received a two-year grant from the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development to investigate the best way to feed children during critical illness. The study is titled, "Supplemental Parenteral Nutrition in Pediatric Respiratory Failure," or "the Supper Study," for short.
"Nutrition affects everything in critical care," said Typpo. "It affects wound healing, the patient's ability to recover, his or her likelihood of getting another infection while in the ICU and even long-term neurological development."
"Currently, nutrition for critically ill children involves feeding them through the GI tract, known as enteral nutrition," said Typpo. "And then, late into their illness, if they fail to tolerate food and nutrition, we add IV nutrition." This method is based on research findings from adult intensive care studies that showed critically ill adults benefit from IV nutrition only late in the course of their illness.
"Where do older infants and children who are critically ill fit into this?" Typpo asked.
She explained that studies support the need to feed critically ill premature infants immediately with IV nutrition, and adult intensive care unit studies recommending you should wait, and provide IV nutrition later.
"It's hard to apply adult data to children because children, unlike adults, have ongoing neurologic growth and development," she said. "It's more likely that infants and children in the PICU are more like the premature infants who need early IV nutrition, because they also have ongoing neurologic growth and development."
Typpo's research lab hypothesizes that optimized early protein and calorie delivery will improve nutritional outcomes and long-term neuro-developmental outcome after pediatric critical illness.
"This study is significant because we expect to improve our understanding of optimal timing for TPN support during pediatric critical illness," said Typpo. "An improved understanding of optimal delivery of nutritional support and the interaction between route and dose of TPN and enteral nutrition—feeding through the GI tract—has the potential to reduce morbidity due to pediatric critical illness, an outcome with lifelong impact."
The study will randomize critically ill children hospitalized in the PICU at The University of Arizona Medical Center-Diamond Children's. Children enrolled in the study either will receive early IV nutrition (within 12 hours of being admitted) or late IV nutrition, which is added to supplement enteral nutrition after five days, which is the current standard of care.
A metabolic cart will be used to measure the exact calorie needs of each child. "Calorie requirements vary widely with children," said Typpo. "By using the metabolic cart, we'll be able to determine how many calories each child uses. It's as important to avoid too much nutrition as it is to avoid malnutrition," she explained.
Typpo anticipates enrolling approximately 40 patients over the next two years, with the goal to expand the study to additional pediatric medical centers throughout the United States.
"We're interested in gathering data about how even a brief lack of nutrition may have a significant impact on a child's neurological development, so that we can develop evidence-based best practices to supply critically ill infants and children with the correct amount of nutrition they need, ensuring the best outcomes."