Pediatric enteral nutrition therapy for burn victims: when should it be initiated?

Valentini, Mariéle; Seganfredo, Fernanda Braga; Fernandes, Sabrina Alves

doi:10.5935/0103-507X.20190062

Mariéle Valentini Corresponding author: Mariéle Valentini, Setor de Nutrição do Hospital de Pronto Socorro de Porto Alegre, Largo Teodoro Herzl, s/nº - Cidade Baixa, Zip code: 90040-192 - Porto Alegre (RS), Brazil, E-mail: marielevalentini@hotmail.com

Hospital de Pronto Socorro de Porto Alegre - Porto Alegre (RS), Brazil.

http://orcid.org/0000-0002-7839-1625

Fernanda Braga Seganfredo

Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brazil.

Sabrina Alves Fernandes

Centro Universitário Metodista IPA - Porto Alegre (RS), Brazil.

Corresponding author: Mariéle Valentini, Setor de Nutrição do Hospital de Pronto Socorro de Porto Alegre, Largo Teodoro Herzl, s/nº - Cidade Baixa, Zip code: 90040-192 - Porto Alegre (RS), Brazil, E-mail: marielevalentini@hotmail.com

Conflicts of interest: None.

Responsible editor: Jefferson Pedro Piva

Author (country)	Design	Inclusion criteria			Exclusion criteria	Intervention
Author (country)	Design	Age	BSA	Admission to burn intensive care unit	Exclusion criteria	Intervention
Gottschlich et al.⁽¹²12 Gottschlich MM, Jenkins ME, Mayes T, Khoury J, Kagan RJ, Warden GD. The 2002 Clinical Research Award. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. J Burn Care Rehabil. 2002;23(6):401-15.⁾ (United States)	RCT, nonblinded, single-center	3 - 18 years	> 25%	< 24 hours after the burn	Not reported	EEN (< 24 hours) versus LEN (> 48 hours) nitial feeding volume not reported; increased 5mL every hour in children younger than 3 years and 10 - 20mL/hour in children older than 3 years
Venter et al.⁽¹³13 Venter M, Rode H, Sive A, Visser M. Enteral resuscitation and early enteral feeding in children with major burns--effect on McFarlane response to stress. Burns. 2007;33(4):464-71.⁾ (South Africa)	RCT, nonblinded, single-center	6 months -13 years	≥ 20%	< 24 hours after the burn	Not reported	EEN (< 24 hours) + enteral volume replacement versus LEN (> 48 hours) + conventional IV volume replacement Initial enteral feeding volume of 1mL/kg/h; increased every 3 hours to 2mL/kg, 3mL/kg, 4mL/kg, 5mL/kg and 6mL/kg until reaching the daily calorie goal
Khorasani and Mansouri⁽¹⁴14 Khorasani EN, Mansouri F. Effect of early enteral nutrition on morbidity and mortality in children with burns. Burns. 2010;36(7):1067-71.⁾ (Iran)	RCT, nonblinded, single-center	30 days - 12 years	≥ 10%	< 2 hours after the burn	Previous chronic diseases: diabetes, epilepsy, cerebral palsy, cystic fibrosis	EEN (3 - 6 hours) + enteral volume replacement versus LEN (> 48 hours) + conventional IV volume replacement Initial enteral feeding volume of 1mL/kg/h; increased every 3 hours to 2mL/kg, 3mL/kg, 4 mL/kg, 5mL/kg and 6mL/kg until reaching the daily calorie goal

Author (country)	Sample size (n)	Sex (male/female) (n)	Age (years)	BSA (%)	Admission (days)
Gottschlich et al.⁽¹²12 Gottschlich MM, Jenkins ME, Mayes T, Khoury J, Kagan RJ, Warden GD. The 2002 Clinical Research Award. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. J Burn Care Rehabil. 2002;23(6):401-15.⁾ (United States)	EEN: 36 LEN: 36	EEN: 28/8 LEN: 22/14	EEN: 9.1 (0.7) LEN: 9.6 (0.7)	EEN: 51.1 (3.2) LEN: 53.2 (3.4)	EEN: 0.5 (0.1) LEN: 0.6 (0.1)
Venter et al.⁽¹³13 Venter M, Rode H, Sive A, Visser M. Enteral resuscitation and early enteral feeding in children with major burns--effect on McFarlane response to stress. Burns. 2007;33(4):464-71.⁾ (South Africa)	EEN: 11 LEN: 10	Not reported	EEN: 4.54 LEN: 4.45^* * expressed as the median.	EEN: 29.5 LEN: 30.0^* * expressed as the median.	Not reported
Khorasani and Mansouri⁽¹⁴14 Khorasani EN, Mansouri F. Effect of early enteral nutrition on morbidity and mortality in children with burns. Burns. 2010;36(7):1067-71.⁾ (Iran)	EEN: 366 LEN: 322	Not reported	EEN: 5.0 (3.5) LEN: 5.0 (3.0)	EEN: 22 (15) LEN: 20 (13)	Not reported

Author (country)	Burn type (%)	Feeding route	Start of feeding (hours)	Type of diet	Time to achieve goal (hours)
Gottschlich et al.⁽¹²12 Gottschlich MM, Jenkins ME, Mayes T, Khoury J, Kagan RJ, Warden GD. The 2002 Clinical Research Award. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. J Burn Care Rehabil. 2002;23(6):401-15.⁾ (United States)	Not reported	Nasoduodenal tube	EEN: 15.6 (1.0) LEN: 48.5 (0.4) (p < 0.0001)	Hyperproteic, hypolipidemic, fiber-free polymeric formula, CD 1.0kcal/mL Composition: 60 - 65% carbohydrates 23% proteins 12 - 15% fats	EEN: 30.3 (2.9) LEN: 50.3 (2.1) (p < 0.0001)
Venter et al.⁽¹³13 Venter M, Rode H, Sive A, Visser M. Enteral resuscitation and early enteral feeding in children with major burns--effect on McFarlane response to stress. Burns. 2007;33(4):464-71.⁾ (South Africa)	EEN: Scalding: 45% Flame: 55% LEN: Scalding: 40% Flame: 60%	Nasojejunal tube and oral route	EEN: 10.7 (5.5 - 23) LEN: 54 (51 - 58)^* * expressed as the median (95% confidence interval).	Polymeric formula and supplementation of glucose polymer and hydrolyzed protein on the 3^rd day in the EEN group and on the 5^th day in the LEN Composition: ± 55 - 58% carbohydrates ± 17 - 20% proteins ± 22 - 28% fats	EEN: 16 (13 - 24) LEN: 10 (7 - 10)^* * expressed as the median (95% confidence interval).
Khorasani and Mansouri⁽¹⁴14 Khorasani EN, Mansouri F. Effect of early enteral nutrition on morbidity and mortality in children with burns. Burns. 2010;36(7):1067-71.⁾ (Iran)	EEN: Scalding: 69% Flame: 27% Electrical: 4% LEN: Scalding: 70% Flame: 26% Electrical: 4%	Nasojejunal tube and oral route	EEN: 3 - 6 LEN: > 48	Polymeric formula and supplementation of glucose polymer and hydrolyzed protein on the 3^rd day in the EEN group and on the 5^th day in the LEN Composition: ± 55 - 58% carbohydrates ± 17 - 20% proteins ± 22 - 28% fats	Not reported

Study identification	Gottschlich et al.⁽¹²12 Gottschlich MM, Jenkins ME, Mayes T, Khoury J, Kagan RJ, Warden GD. The 2002 Clinical Research Award. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. J Burn Care Rehabil. 2002;23(6):401-15.⁾
Study type	RCT
Bias	Risk of bias assessed by the authors	Justification of the assessment
Sequence generation	Low	Randomized upon admission
Allocation concealment	Low	Randomized upon admission
Blinding of participants, researchers or outcome assessment	Moderate	Not blinded but the results are probably not affected
Incomplete outcome data	Low	Explained the loss of patients
Selective reporting of outcomes	Low	Specific results were reported
Other sources of bias	Low	There seems to be no other sources of bias
Study identification	Venter et al.⁽¹³13 Venter M, Rode H, Sive A, Visser M. Enteral resuscitation and early enteral feeding in children with major burns--effect on McFarlane response to stress. Burns. 2007;33(4):464-71.⁾
Study type	RCT
Bias	Risk of bias assessed by the authors	Justification of the assessment
Sequence generation	Moderate	Randomized but do not explain how
Allocation concealment	Low	Randomized upon admission
Blinding of participants, researchers or outcome assessment	Moderate	Not blinded but the results are probably not affected
Incomplete outcome data	Low	Explained the loss of patients
Selective reporting of outcomes	Low	Specific results were reported
Other sources of bias	Low	There seems to be no other sources of bias
Study identification	Khorasani and Mansouri⁽¹⁴14 Khorasani EN, Mansouri F. Effect of early enteral nutrition on morbidity and mortality in children with burns. Burns. 2010;36(7):1067-71.⁾
Study type	RCT
Bias	Risk of bias assessed by the authors	Justification of the assessment
Sequence generation	Low	Randomized according to the date of admission
Allocation concealment	Low	Randomized according to the date of admission
Blinding of participants, researchers or outcome assessment	Moderate	Not blinded but the results are probably not affected
Incomplete outcome data	Low	All patients completed the study
Selective reporting of outcomes	Low	Specific results were reported
Other sources of bias	Low	There seems to be no other sources of bias

Database		Terms
MEDLINE (via PubMed)	#1	burnt child OR burnt children OR child burn OR children burn OR paediatrics burn OR pediatrics burn OR paediatric burn OR pediatric burn OR “Burns”[Mesh] OR Burn OR Burns OR “Fires”[Mesh] OR Fire OR Fires OR “Child Nutrition Disorders”[Mesh] OR “Child, Hospitalized”[Mesh]
		AND
	#2	"Nutritional Support"[Mesh] OR Nutritional Support OR Artificial Feeding OR Nutritional Therapy OR Nutritional Treatment
Cochrane	#1	burnt child OR burnt children OR child burn OR children burn OR paediatrics burn OR pediatrics burn OR paediatric burn OR pediatric burn OR “Burns” OR Burn OR Burns OR “Fires” OR Fire OR Fires OR “Child Nutrition Disorders” OR “Child, Hospitalized”
		AND
	#2	"Nutritional Support" OR Nutritional Support OR Artificial Feeding OR Nutritional Therapy OR Nutritional Treatment
Embase	#1	(‘fire’/exp OR ‘burn’/exp OR ‘burn center’ OR ‘burn complication’ OR ‘burn injury’ OR ‘burn trauma’ OR ‘burn wound’ OR ‘burning’ OR ‘burns’ OR ‘deep burn’ OR ‘skin burn’ OR ‘thermal burn’ OR ‘third degree burn’ OR ‘burnt child’ OR ‘burnt children’ OR ‘child burn’ OR ‘children burn’ OR ‘paediatrics burn’ OR ‘pediatrics burn’ OR ‘paediatric burn’ OR ‘pediatric burn’ OR ‘Burn’ OR ‘Fire’ OR ‘Fires’)
		AND
	#2	('nutritional support'/exp OR 'Nutritional Support' OR 'Artificial Feeding' OR 'Nutritional Therapy' OR 'Nutritional Treatment')

Base de dados		Termos
MEDLINE (via PubMed)	#1	burnt child OR burnt children OR child burn OR children burn OR paediatrics burn OR pediatrics burn OR paediatric burn OR pediatric burn OR “Burns”[Mesh] OR Burn OR Burns OR “Fires”[Mesh] OR Fire OR Fires OR “Child Nutrition Disorders”[Mesh] OR “Child, Hospitalized”[Mesh]
		AND
	#2	"Nutritional Support"[Mesh] OR Nutritional Support OR Artificial Feeding OR Nutritional Therapy OR Nutritional Treatment
Cochrane	#1	burnt child OR burnt children OR child burn OR children burn OR paediatrics burn OR pediatrics burn OR paediatric burn OR pediatric burn OR “Burns” OR Burn OR Burns OR “Fires” OR Fire OR Fires OR “Child Nutrition Disorders” OR “Child, Hospitalized”
		AND
	#2	"Nutritional Support" OR Nutritional Support OR Artificial Feeding OR Nutritional Therapy OR Nutritional Treatment
Embase
	#1	(‘fire’/exp OR ‘burn’/exp OR ‘burn center’ OR ‘burn complication’ OR ‘burn injury’ OR ‘burn trauma’ OR ‘burn wound’ OR ‘burning’ OR ‘burns’ OR ‘deep burn’ OR ‘skin burn’ OR ‘thermal burn’ OR ‘third degree burn’ OR ‘burnt child’ OR ‘burnt children’ OR ‘child burn’ OR ‘children burn’ OR ‘paediatrics burn’ OR ‘pediatrics burn’ OR ‘paediatric burn’ OR ‘pediatric burn’ OR ‘Burn’ OR ‘Fire’ OR ‘Fires’)
		AND
	#2	('nutritional support'/exp OR 'Nutritional Support' OR 'Artificial Feeding' OR 'Nutritional Therapy' OR 'Nutritional Treatment')

[1] Corresponding author: Mariéle Valentini, Setor de Nutrição do Hospital de Pronto Socorro de Porto Alegre, Largo Teodoro Herzl, s/nº - Cidade Baixa, Zip code: 90040-192 - Porto Alegre (RS), Brazil, E-mail: marielevalentini@hotmail.com

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Pediatric enteral nutrition therapy for burn victims: when should it be initiated?

ABSTRACT

Objective:

Methods:

Results:

Conclusion: