Abstract
The metabolic response to stress and infection is closely related to the corresponding requirements of energy and nutrients. On a general level, the response is driven by a complex endocrine network and related to the nature and severity of the insult. On an individual level, the effects of nutritional interventions are highly variable and a possible source of complications. This narrative review aims to discuss the metabolic changes in critically-ill children and the potential of developing personalized nutritional interventions. Through a literature search strategy, we have investigated the importance of blood glucose levels, the nutritional aspects of the different phases of acute stress response, and the reliability of the available tools to assess the energy expenditure. The dynamics of metabolism during stressful events reveal the difficult balance between risk of hypo- or hyperglycemia and under- or overfeeding. Within this context, individualized and accurate measurement of energy expenditure may help in defining the metabolic needs of patients. Given the variability of the metabolic response in critical conditions, randomized clinical studies in ill children are needed to evaluate the effect of individualized nutritional intervention on health outcomes.
Highlights
Acute stress conditions, such as sepsis or severe infections, are the major causes of admission into pediatric intensive care units (PICUs) [1]
We carried out the search to identify the articles published in English on (i) glycemic control, (ii) nutritional interventions in the different acute stress phases, (iii) the role of the parenteral nutrition and of the immunity-enhancers nutrients and, (iv) the usefulness of predictive equations and indirect calorimetry use in critically ill children
We focused on data on infective events, need of mechanical ventilation, length of PICU stay, and mortality rate for the different nutritional approaches
Summary
Acute stress conditions, such as sepsis or severe infections, are the major causes of admission into pediatric intensive care units (PICUs) [1]. The metabolic response to these conditions has precise pathophysiological mechanisms, clinical consequences, and therapeutic implications. It is divided into three phases—the acute phase, the stable phase, and the recovery phase—all characterized by specific neuroendocrine, metabolic, and immunologic modifications [2]. Infection-induced nutritional deficiencies appear to diminish immune responsiveness and impair antimicrobial defensive mechanisms, making the host more susceptible to secondary or opportunistic infections [9] Considering these metabolic alterations and the risk of hyper- or hypo-metabolism [10], nutritional interventions may be crucial to improving the response of the host [11]. The aim of this narrative review is to discuss in view of the novel insights:
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