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Surgical Nutrition

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Pediatric Trauma Care

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Abstract

Nutritional support after pediatric trauma is designed to provide adequate calories and protein to mitigate the effects of the catabolic injury response, preserve lean body mass through improved nitrogen balance, and decrease recovery time and morbidity. Estimation of energy and protein needs should take into consideration patient age, as well as severity and mechanism of injury. Provision of adequate protein is likely the most important intervention after trauma, as it leads to improved nitrogen balance. Enteral nutrition (EN) is the preferred route for feeding when oral feeding is inadequate and should be initiated early in the post-injury period after resuscitation is complete, typically within 24–48 h. Continuous intragastric tube feedings are started at a low rate and progressively advanced towards goal. Post-pyloric feedings are utilized for patients with high aspiration risk or in those who do not tolerate gastric feedings. Parenteral nutrition (PN) is indicated for patients in whom EN is contraindicated or inadequate. Because of concern for hyperglycemia and associated infection risk in the acute post-injury phase, PN initiation is typically delayed for 48–72 h. Patients with normal gastrointestinal (GI) function can receive standard, polymeric formulas, while those with impaired GI function benefit from peptide-based or elemental formulas that minimize intestinal work. A feeding protocol should be utilized to ensure that estimated energy and protein requirements are being met through the delivery of adequate nutrition. Necessary monitoring includes anthropometrics and biochemical markers, as well as clinical parameters of feeding tolerance, such as GI symptoms and abdominal examination findings. Feeding interruptions are a significant challenge to the delivery of optimal enteral nutrition that leads to delayed achievement of caloric goals and increased PN utilization. Surveillance and awareness of the preventable causes of these interruptions allow for targeted interventions to facilitate EN delivery.

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References

  1. Cook RC, Blinman TA. Nutritional support of the pediatric trauma patient. Semin Ped Surg. 2010;19:242–51.

    Article  Google Scholar 

  2. Jacobs DG, Jacobs DO, Kudsk KA, et al. Practice management guidelines for nutritional support of the trauma patient. J Trauma. 2004;57:660–79.

    Article  Google Scholar 

  3. Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. J Parenter Enter Nutr. 2017;41:706–42.

    Article  Google Scholar 

  4. Petrillo-Albarano T, Pettignano R, Asfaw M, et al. Use of a feeding protocol to improve nutritional support through early, aggressive, enteral nutrition in the pediatric intensive care unit. Pediatr Crit Care Med. 2006;7:340–4.

    Article  Google Scholar 

  5. Hamilton S, McAleer DM, Ariagno K, et al. A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals. Pediatr Crit Care Med. 2014;15:583–9.

    Article  Google Scholar 

  6. Spurlock DM, Anderson IC. Trauma nutrition protocol. Children’s Hospital of The King’s Daughters. 2019.

    Google Scholar 

  7. Coss-Bu JA, Hamilton-Reeves J, Patel JJ, et al. Protein requirements of the critically ill pediatric patient. Nutr Clin Pract. 2017;32(Supp 1):128S–41S.

    Article  CAS  Google Scholar 

  8. Velazco CS, Zurakowski D, Fullerton BS, et al. Nutrient delivery in mechanically ventilated surgical patients in the pediatric critical care unit. J Pediatr Surg. 2017;52:145–8.

    Article  Google Scholar 

  9. Mehta NM, Compher C, A.S.P.E.N. Board of Directors. Clinical guidelines: nutrition support of the critically ill child. J Parenter Enter Nutr. 2009;33(3):260–76.

    Article  Google Scholar 

  10. Bechard LJ, Parrott JS, Mehta NM. Systematic review of the influence of energy and protein intake on protein balance in critically ill children. J Pediatr. 2012;161:333–9.

    Article  Google Scholar 

  11. Gomez IJA, Gonzalez CB, Palacio PAM, et al. Nutritional support of the critically ill pediatric patient: foundations and controversies. Clin Med Insights Trauma Intensive Med. 2017;8:1–7.

    CAS  Google Scholar 

  12. Miller KR, Smith JW, Harbrecht BG, et al. Early enteral nutrition in trauma: is there still any doubt? Curr Trauma Rep. 2016;2:73–8.

    Article  Google Scholar 

  13. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38:48–79.

    Article  Google Scholar 

  14. Burlew CC, Moore EE, Cuschieri J, et al. Who should we feed? Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. J Trauma Acute Care Surg. 2012;73:1380–7.

    Article  Google Scholar 

  15. Mehta NM, McAleer D, Hamilton S, et al. Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit. J Parenter Enter Nutr. 2010;34:38–45.

    Article  Google Scholar 

  16. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enter Nutr. 2016;40:159–211.

    Article  CAS  Google Scholar 

  17. Prelack K, Dylewshi M, Sheridan RL. Practice guidelines for nutritional assessment of burn injury and recovery. Burns. 2007;33:14–24.

    Article  Google Scholar 

  18. Rodriguez NA, Jeschke MG, Williams FN, et al. Nutrition in burns: Galveston contributions. J Parenter Enter Nutr. 2011;35(6):704–14.

    Article  CAS  Google Scholar 

  19. Cook AM, Peppard A, Magnuson B. Nutrition considerations in traumatic brain injury. Nutr Clin Pract. 2008;23:608–20.

    Article  Google Scholar 

  20. A.S.P.E.N. Board of Directors. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enter Nutr. 2002;26:1SA–138SA.

    Google Scholar 

  21. Joosten K, Embleton N, Yan W, et al. ESPGHAN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: energy. Clin Nutr. 2018;37:2309–14.

    Article  CAS  Google Scholar 

  22. Balakrishnan B, Flynn-O’Brien KT, Simpson PM, et al. Enteral nutrition initiation in children admitted to pediatric intensive care units after traumatic brain injury. Neurocrit Care. 2019;30:193–200.

    Article  CAS  Google Scholar 

  23. Hegazi RA, Wischmeyer PE. Clinical review: optimizing enteral nutrition for critically ill patients—a simple data-driven formula. Crit Care. 2011;15:234.

    Article  Google Scholar 

  24. Berger MM, Reintam-Blaser A, Calder PC, et al. Monitoring nutrition in the ICU. Clin Nutr. 2019;38:584–93.

    Article  Google Scholar 

  25. Martinez EE, Bechard LJ, Mehta NM. Nutrition algorithms and bedside nutrient delivery practices in pediatric intensive care units: an international multicenter cohort study. Nutr Clin Pract. 2014;29:360–7.

    Article  Google Scholar 

Further Reading

  • Fivez T, Kerklaan D, Mesotten D, et al. Early versus late parenteral nutrition in critically ill children. N Engl J Med. 2016;374:1111–22.

    Article  CAS  Google Scholar 

  • Kochanek PM, Tasker RC, Carney N, et al. Guidelines for the management of pediatric severe traumatic brain injury, 3rd edition: Update of the Brain Trauma Foundation guidelines. Pediatr Crit Care Med. 2019;20:S1–S82.

    Article  Google Scholar 

  • Miller KR, Smith JW, Harbrecht BG, et al. Early enteral nutrition in trauma: is there still any doubt? Curr Trauma Rep. 2016;2:73–8.

    Article  Google Scholar 

  • Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36:623–50.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Children’s Hospital of the King’s Daughter, Norfolk, VA, USA

    Frazier Frantz

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  1. Frazier Frantz
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Correspondence to Frazier Frantz .

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Editors and Affiliations

  1. Geisinger Medical Center, Danville, VA, USA

    Alfred P. Kennedy Jr

  2. University of California, San Diego, La Jolla, CA, USA

    Romeo C. Ignacio

  3. Prisma Health/Greenville Memorial Hospital, Greenville, SC, USA

    Robert Ricca

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Frantz, F. (2022). Surgical Nutrition. In: Kennedy Jr, A.P., Ignacio, R.C., Ricca, R. (eds) Pediatric Trauma Care . Springer, Cham. https://doi.org/10.1007/978-3-031-08667-0_12

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  • DOI: https://doi.org/10.1007/978-3-031-08667-0_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-08666-3

  • Online ISBN: 978-3-031-08667-0

  • eBook Packages: MedicineMedicine (R0)

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