Dados do Trabalho

Título

The Impact of Early Enteral Nutrition in Critically Ill Children: A Systematic Review and Meta-analysis

Objetivo

Early enteral nutrition (EEN) in pediatric intensive care units (PICU) is typically started within the first 24 to 72 hours, but its optimal timing and impact are debated. This study evaluates how EEN compares to late enteral nutrition (LEN) concerning clinical outcomes in critically ill children.

Métodos

We systematically searched PubMed, Embase, and the Cochrane Library from inception to August 2024. The primary outcome was all-cause mortality, with secondary outcomes including mechanical ventilation duration and PICU and hospital lengths of stay. Meta-analysis used a random-effects model with inverse variance weighting.

Resultados

Twenty studies involving 10,009 children were included. Definitions of EEN varied from 24 to 72 hours. EEN was linked to decreased mortality in both randomized clinical trials [odds ratio (OR) = 0.64; 95% confidence interval (CI), 0.43 to 0.96; p = 0.03] and observational studies [OR = 0.38; 95% CI, 0.23 to 0.62; p < 0.001]. Sensitivity analysis showed that EEN within 24 hours was not significantly associated with mortality [OR = 0.72; 95% CI, 0.43 to 1.20; p = 0.21], whereas EEN within 48 hours significantly reduced mortality [OR = 0.37; 95% CI, 0.25 to 0.56; p < 0.001]. EEN also significantly reduced hospital stays, but had no significant effect on mechanical ventilation duration or PICU stay compared to LEN.

Conclusão

EEN is beneficial for critically ill children by lowering mortality and hospital stays. However, the reliance on observational studies and lack of large-scale RCTs highlight the need for further research.