Fran Lowry

February 29, 2016

ORLANDO, Florida — For children who have experienced traumatic brain injury, early nutritional support is associated with better outcomes and less mortality, according to a secondary analysis.

"What is exciting about our findings is that kids seemed to have a better outcome, both with respect to mortality and to functional outcomes, if they were fed within 72 hours of being in the ICU," said Elizabeth Meinert, MD, from the University of Pittsburgh Medical Center.

"There are a lot of high-tech and physiology-focused treatments for traumatic brain injury, and I think that sometimes we forget about feeding these kids because we're so worried about their brains," she told Medscape Medical News.

"It's important to remember that nutrition is another treatment for the brain, basically," Dr Meinert said here at the Society of Critical Care Medicine's 45th Critical Care Congress.

Dr Elizabeth Meinert

In their study, Dr Meinert and her team used data from the Cool Kids Trial (Lancet Neurol. 2013;12:546-553), which evaluated therapeutic hypothermia as a treatment for traumatic brain injury in children. In that study, the researchers randomized 77 children to receive hypothermia or normothermia; 13.3% of the patients died.

The Cool Kids researchers also collected information that wasn't relevant to hypothermia as a treatment, including the timing of nutrition initiation, Dr Meinert reported. This additional information was used by her team "to do our own statistical analysis, and to look at nutrition specifically," she said.

It's important to remember that nutrition is another treatment for the brain.

The timing of nutritional support varied widely; 35.5% of the children received nutritional support 48 hours or less after the traumatic brain injury, 40.0% received it 48 to 72 hours after the injury, 18.9% received it more than 72 hours after the injury, and 5.6% received no nutritional support during the study period.

The mortality rate was significantly higher in the children who did not receive any nutritional support than in those who did (P < .05), and outcomes — measured with the Pediatric Glasgow Outcome Scale–Extended — were significantly worse (P < .05).

Nutrition Allows Healing

Dr Lori Shutter

"There's an increasing focus on good nutrition in ICUs and, while that's common sense, it's nice to actually have some data to support that we do need to address nutrition early," said Lori Shutter, MD, from the University of Pittsburgh Medical Center, who moderated the oral session.

"This study looked at this issue in a controlled fashion, and was able to tell us that there is an association between nutrition and long-term mortality," she told Medscape Medical News.

"Of course, good medical care is important, and we need to pay attention to detail, but sometimes we need to be reminded that common, basic care is also really important," Dr Shutter explained.

"You're so busy putting in lines, you're so busy saving lives, you're so busy putting in all these fancy monitors that you sometimes forget the very basics of just feeding somebody, and that may help with the entire immunologic cascade," she added.

"In managing patients in the ICU, we also need to create an optimum environment to allow some natural healing, and nutrition is a component of that optimal environment that we often overlook."

Dr Meinert and Dr Shutter have disclosed no relevant financial relationships.

Society of Critical Care Medicine's (SCCM) 45th Critical Care Congress: Abstract 17. Presented February 21, 2016.


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