背景:营养不良影响50%的住院儿童和25-70%的危重儿童。对于危重的儿科患者,通常认为肠内导管喂养是优选的方式。在危重患儿中,使用基于肽的配方的临床优势仍然存在争议。这项研究的目的是比较基于肽的配方与标准聚合物配方对喂养耐受性的影响,以及这是否会影响危重儿童的结局。
方法:这项单盲病例对照研究是对AinShams大学儿科重症监护病房(PICU)中随机选择的180名危重患儿进行的。将患者分为2组:接受标准聚合物配方的组(组1;90名患者)和接受基于肽的配方的组(组II;90名患者)。营养需求,达到完全肠内喂养的天数,我们记录了所有患者入院时的进食不耐受症状和人体测量值,以及他们的儿科死亡风险评分(PRISM).PICU停留的长度,在出院时分析脓毒症的发生率和生存率作为结局指标.
结果:接受基于肽的配方的患者在进食中断和腹胀方面显着减少(p<0.000),更快达到完全肠内喂养(2.60±0.74天,接受聚合物标准配方的患者为5.36±1.00天;p<0.001),并改善体重增加(p<0.028).此外,脓毒症的持续时间明显缩短(p<0.045),但两组患者的死亡率无差异.
结论:在危重患儿中,基于肽的配方喂养比标准聚合物配方喂养具有更好的耐受性。然而,接受基于肽的配方的患者的选择需要进一步评估.
BACKGROUND: Malnutrition affects 50% of hospitalized children and 25-70% of critically ill children. Enteral tube feeding is generally considered the preferred modality for critically ill pediatric patients. Clinical advantages of using peptide-based formulas are still controversial in critically ill children. The aim of this study was to compare the effect of a peptide-based formula versus a standard polymeric formula on feeding tolerance and whether this will affect the outcome among critically ill children.
METHODS: This single blind case control study was conducted on 180 randomly selected critically ill children in the pediatric critical care unit (PICU) of Ain Shams University. Patients were divided into 2 groups: a group receiving a standard polymeric formula (group 1; 90 patients) and a group receiving a peptide-based formula (group II; 90 patients). Nutritional requirements, days to reach full enteral feeding, feeding intolerance symptoms and anthropometric measurements were recorded for all patients at admission together with their pediatric risk of mortality score (PRISM). Length of PICU stay, occurrence of sepsis together with survival were analyzed at discharge as outcome measures.
RESULTS: Patients receiving a peptide-based formula showed a significant decrease in feeding interruptions and abdominal distention (p < 0.000), reached full enteral feeding faster (2.60 ±0.74 days versus 5.36 ±1.00 days in patients received polymeric standard formula; p < 0.001) and improved weight gain (p < 0.028). Moreover, duration of sepsis was significantly shorter (p < 0.045), but no difference in mortality was recorded between patient groups.
CONCLUSIONS: Peptide-based formula feeding was better tolerated than standard polymeric formula feeding in critically ill pediatric patients. However, the choice of patients receiving the peptide-based formula needs to be further evaluated.