Good research on pediatric nutrition in the ICU let down by skimpy news release

Our Review Summary

This brief news release, issued by a university hospital system in Belgium, is loosely based on published results of a multinational, randomized clinical study designed to test the value of adding early intravenous macronutrient feedings to the nutritional care of critically ill children in intensive care units who are unable to eat or be fed normally. Such so-called “total” parenteral nutrition, delivered via the bloodstream, is commonplace in pediatric ICUs, researchers say, because of concerns that “macronutrient deficits” will lead to increased infections, weakness, and longer stays on ventilators and in ICUs overall. The problem, however, has been the dearth of rigorous scientific evidence for this assumption in children, and — significantly — growing evidence in studies of adults that the practice actually delays healing and increases infections.

The study on which the release is based does indeed add strong clinical evidence that the same is true for children, and that delaying for a week or so the use of full parenteral feedings is clearly associated with lower rates of infections and earlier discharge from the ICUs. But this release could leave some readers with the misconception that starving critically ill children will hasten their recovery from a critical illness. Here’s why: contrary to the language in the release, the study did not “prove” the idea that “receiving little or no nutrition” in the first week of an ICU stay “makes children recover faster.” Nor were these children “fasting,” in the conventional sense. In fact, all of the children received micronutrients (such as vitamins and minerals), blood sugar controls, and “enteral” nutrition in which some nutrients are delivered through a tube from the nose to the stomach. The release further misleadingly implies that “nutritional deficiency” somehow directly leads to faster and better recoveries for seriously ill children; in fact, the authors of the published study report that the reason for the benefit of delaying total parenteral nutrition remains “speculative,” but possibly due to complex effects of digestion and metabolism that have an impact on the immune system. 

Why This Matters

Although numbers are hard to come by (and the release makes no effort to find any) an estimated quarter million infants and children a year are admitted to intensive care units with critical illnesses and injuries. Scientists know that  the nutritional needs of children’s rapidly growing brains and bodies make their care trickier in some respects than adult care, and the use of intravenous feedings of a complete package of calories and specific nutrients are commonly started within 24 hours of an ICU stay. But few studies have been done to test the value of such feedings, usually given as supplements or sometimes in place of enteral feedings of some nutrients through a nasogastric tube. And studies in adults have strongly suggested that parenteral feedings are associated with higher rates of infection and longer ICU stays. This study matters because treatment of children in the ICU is not uncommon and the outcomes of interest (time in the ICU, complication rates, death) are important to everyone.