高密度肠内配方在危重儿科患者中的应用：一项系统综述和荟萃分析。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-18 DOI:10.1016/j.clnesp.2025.03.025

Natsuhiro Yamamoto , Yoshiyuki Shimizu , Keichiro Shimoyama , Aya Tampo , Norihiko Tsuboi , Ryo Yamamoto , Yujiro Matsuishi , Kensuke Nakamura , Joji Kotani

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引用次数: 0

摘要

背景和目的：危重儿科患者，特别是婴儿，即使在急性期也需要足够的营养，因为他们处于营养不良的高风险中。通常需要限制水分，以避免流体过载的不利影响。服用能量或蛋白质密集的肠内配方被认为是同时达到这些要求的潜在治疗策略。本研究旨在通过系统评价和荟萃分析来评估能量或蛋白质密集肠内配方的有效性和安全性。方法：我们于2023年4月通过PubMed、Cochrane中央对照试验注册库和igaku - chuo - zashi检索MEDLINE，比较高密度配方奶粉（大于0.9 kcal/mL）和标准密度配方奶粉（0.67至小于0.9 kcal/mL）在接受人工配方肠内营养的危重儿科患者中的随机对照试验。主要结局是死亡率，次要结局包括重症监护病房（ICU）的住院时间、机械通气持续时间、不良事件（呕吐、腹泻和胃肠道出血）和年龄体重比Z评分（WAZ）。数据提取和偏倚风险评估由两名独立审稿人使用Cochrane偏倚风险评估工具进行。使用随机效应模型进行meta分析，并使用分级推荐评估、发展和评估方法评估结果的确定性。结果：meta分析纳入了7项研究，涉及542例患者。这七项研究中有六项包括先天性心脏病患者，其余研究包括因病毒感染导致急性呼吸衰竭的婴儿。对死亡率的影响不显著（风险比：2.05,95%可信区间：[CI] 0.76-5.50， P=0.16，低确定性）。ICU住院时间、住院时间、机械通气持续时间或不良事件均无显著影响。高密度方剂对提高WAZ有显著作用（平均差值：0.61,95% CI: 0.28-0.94, p）。结论：高密度方剂对提高WAZ有显著作用。进一步的调查将有助于提高这一证据的确定性。

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High-density enteral formula in critically ill pediatric patients: A systematic review and meta-analysis

Background and aims

Critically ill pediatric patients, particularly infants, require sufficient nutrition even in the acute phase because they are at a high risk of malnutrition. Water restrictions are frequently required to avoid the adverse effects of fluid overload. Administration of energy or protein-dense enteral formulas is considered a potential therapeutic strategy to achieve these requirements simultaneously. This study aimed to assess efficacy and safety of energy or protein-dense enteral formula through a systematic review and meta-analysis.

Methods

We searched MEDLINE via PubMed, Cochrane Central Register of Controlled Trials, and Igaku-Chuo-Zasshi in April 2023 for randomized controlled trials comparing high-density formulas (more than 0.9 kcal/mL) to standard-density formulas (0.67 to less than 0.9 kcal/mL) in critically ill pediatric patients undergoing enteral nutrition by artificial formula. The primary outcome was mortality, and secondary outcomes included length of stay in the intensive care unit (ICU), duration of mechanical ventilation, adverse events (emesis, diarrhea, and gastrointestinal bleeding), and weight-for-age Z score (WAZ). Data extraction and risk of bias assessment were performed by two independent reviewers using the Cochrane risk-of-bias tool. A meta-analysis was conducted using a random-effects model, and the certainty of the findings was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology.

Results

Seven studies involving 542 patients were included in the meta-analysis. Six of these seven studies included patients with congenital heart disease, and the remaining study included infants with acute respiratory failure due to viral infection. The effects on mortality were not significant (risk ratio: 2.05, 95 % confidence interval: [CI] 0.76–5.50, P = 0.16, low certainty). No significant effects were observed on length of ICU stay, length of hospital stay, duration of mechanical ventilation, or adverse events. High-density formulas had a significant effect on increasing WAZ (mean difference: 0.61, 95 % CI: 0.28–0.94, P < 0.001, low certainty).

Conclusion

Our results showed that the administration of high-density formulas was effective in increasing WAZ. Further investigation will contribute to improving the certainty of this evidence.

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.