Children being treated in intensive care recover more quickly without artificial feeding, contrary to current practice, according to a team of international researchers.
The study, published in the New England Journal of Medicine, showed that receiving little to no nutrition during the first week in intensive care made children recover faster.
“We found that the current practice of feeding children in an early stage does not contribute to their recovery”
Greet Van den Berghe
The findings challenge the current common practice of artificially feeding critically ill children soon after their arrival in ICU, based on the assumption that it will help their recovery.
The method used worldwide is to feed children intravenously during their first days in ICU to strengthen muscles and prevent complications.
The new study was by researchers from University Hospitals Leuven in Belgium, Sophia Children’s Hospital Rotterdam in the Netherlands and Stollery Children’s Hospital Edmonton in Canada.
Their trial, involving 1,440 critically ill children, examined whether fasting or receiving very small amounts of feeding during the first week in paediatric ICU was better than full feeding through an IV.
For 723 patients, parenteral nutrition was initiated within 24 hours after ICU admission, whereas for the other 717 patients it was not provided until the morning of the eighth day in ICU.
In both groups, enteral nutrition was attempted early and intravenous micronutrients were provided.
Although mortality was similar in the two groups, the percentage of patients with a new infection was 10.7% in the group receiving late parenteral nutrition, compared with 18.5% in the group receiving early parenteral nutrition.
The mean duration of ICU stay was around 6.5 days in the group receiving late parenteral nutrition, compared with around 9.2 days in those receiving early nutrition, and there was a higher likelihood of an earlier live discharge from the ICU at any time in the late-parenteral-nutrition group.
In addition, late parenteral nutrition was associated with a shorter duration of mechanical ventilation support, less need for renal-replacement therapy and a shorter duration of hospital stay.
It was also associated with lower plasma levels of γ-glutamyltransferase and alkaline phosphatase than was early parenteral nutrition, as well as higher levels of bilirubin and C-reactive protein.
Children in ICU recover faster with ‘little to no nutrition’
Study author Professor Greet Van den Berghe, from University Hospitals Leuven, said: “We found that the current practice of feeding children in an early stage does not contribute to their recovery.
“On the contrary, the children who had built up a nutritional deficiency after receiving little to no feedings had fewer infections, less organ failure, and a quicker recovery than children who had been fed through the IV,” she said.
“The effect was present in everyone, regardless of the type of disease, the children’s age, or the hospital in which they were staying,” she added.