Диагностика нутритивных нарушений у детей после перенесенной черепно-мозговой травмы (обзор современных рекомендаций)

Abstract

Traumatic brain injury (TBI) is one of the main causes of disability and mortality in the population, and in young people it ranks first. Children after TBI, in addition to neurological problems, have a number of somatic ones, such as malnutrition, dysphagia, and motor disorders of the gastrointestinal tract. Hypercatabolism causes the formation of malnutrition and loss of a significant part of muscle mass in these patients. Gastrointestinal problems limit adequate nutrition. In combination with neurological disorders – motor disorders, long-term immobilization, epilepsy – this can lead to the development of sarcopenia. The presence of sarcopenia, in turn, reduces the rehabilitation potential and directly affects the restoration and acquisition of motor functions. Therefore, it is important to assess and correct nutritional status in children with TBI not only in the acute period, but also during the early restorative treatment. The purpose — to analyze the available literature on the features of assessing nutritional status in children after traumatic brain injury. Results. Children after TBI are prone to immobilization, which leads to loss of muscle mass and bone mineral density, as well as an increase in fat mass. According to the guidelines of the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (ESPGHAN), it is recommended to assess the nutritional status of children with neurological diseases using anthropometry, body composition, and some laboratory parameters. To date, a universal marker of nutritional status disorders in children with neurological diseases in general and with TBI in particular has not been identified. The clinical recommendations «Traumatic brain injury in children» (2022) indicate that such routine laboratory markers of nutrition assessment as total protein, serum albumin, prealbumin, retinol-binding protein, as well as anthropometry have not proven their effectiveness in assessing the state of muscle mass. The «gold standard» in determining the body composition is the bioimpedansometry method, which allows assessing the content of active cell mass, muscle mass, fat and fat-free mass, the total water content. To achieve optimal anthropometric parameters, body composition and rehabilitation prognosis, it is recommended to use indirect calorimetry instead of equations to calculate the resting energy expenditure. Conclusion. The current Federal Clinical Guidelines for the Treatment of Children with TBI (2022) do not have an algorithm and a clear approach to assessing nutritional status and prescribing nutritional support for children of this vulnerable group. To assess the nutritional status, regardless of the level of the hospital, it is recommended to use anthropometry with dynamic control. To assess the body composition it is recommended to use bioimpedansometry, if it is unavailable — mid-upper arm circumference using MUAC tapes, as well as caliperometry. It is also recommended to assess the level of trace elements, with dynamic control at 6 months or annually.