Management of Enteral Nutrition in the Pediatric Intensive Care Unit: Prokinetic Effects of Amoxicillin/ Clavulanate in Real Life Conditions

다국어 초록 (Multilingual Abstract)

Purpose: Malnutrition is a common feature in critically ill children. Enteral nutrition (EN) is the main strategy to nutritionally support critical ill children, but its use can be hindered by the development of intolerance. The study aimed to assess the effectiveness and safety of amoxicillin/clavulanate (A/C) to treat EN intolerance.
Methods: We retrospectively evaluated patients admitted to the pediatric intensive care unit from October 2018 to October 2019. We conducted a case-control study: in the first 6 months (October 2018-April 2019) we implemented the nutritional protocol of our Institution with no drug, whereas in the second half (May 2019-October 2019) we employed A/C for 1 week at a dose of 10 mg/kg twice daily.
Results: Twelve cases were compared with 12 controls. At the final evaluation, enteral intake was significantly higher than that at baseline in the cases (from 2.1±3.7 to 66.1±27.4% of requirement, p=0.0001 by Wilcoxon matched-pairs signed rank test) but not in the controls (from 0.2±0.8 to 6.0±14.1% of the requirement, p=NS). Final gastric residual volume at the end of the observation was significantly lower in the cases than in the controls (p=0.0398). The drug was well tolerated as shown by the similar safety outcomes in both cases and controls.
Conclusion: Malnutrition exposes critically ill children to several complications that affect the severity of disease course, length of stay, and mortality; all may be prevented by early EN. The development of intolerance to EN could be addressed with the use of A/C. Future prospective clinical trials are needed to confirm these conclusions.

참고문헌 (Reference)

1 Kim H, "Why patients in critical care do not receive adequate enteral nutrition? A review of the literature" 27 : 702-713, 2012

2 de Menezes FS, "What are the factors that influence the attainment of satisfactory energy intake in pediatric intensive care unit patients receiving enteral or parenteral nutrition" 29 : 76-80, 2013

3 Ericson JE, "Use and safety of erythromycin and metoclopramide in hospitalized infants" 61 : 334-339, 2015

4 Meyer R, "The impact of enteral feeding protocols on nutritional support in critically ill children" 22 : 428-436, 2009

5 World Health Organization, "The Treatment of diarrhoea: a manual for physicians and other senior health workers" World Health Organization

6 Canarie MF, "Risk factors for delayed enteral nutrition in critically ill children" 16 : e283-9, 2015

7 Braegger C, "Practical approach to paediatric enteral nutrition : a comment by the ESPGHAN committee on nutrition" 51 : 110-122, 2010

8 Tillman EM, "Pharmacologic treatment for pediatric gastroparesis : a review of the literature" 21 : 120-132, 2016

9 Lake JG, "Pathogen distribution and antimicrobial resistance among pediatric healthcare-associated infections reported to the National Healthcare Safety Network, 2011-2014" 39 : 1-11, 2018

10 Thapar N, "Paediatric intestinal pseudoobstruction : evidence and consensus-based recommendations from an ESPGHAN-led expert group" 66 : 991-1019, 2018

11 Mehta NM, "Nutritional deficiencies during critical illness" 56 : 1143-1160, 2009

12 Mehta NM, "Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient : Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition" 18 : 675-715, 2017

13 Hauer J, "Feeding intolerance in children with severe impairment of the central nervous system: strategies for treatment and prevention" 5 : 1-, 2017

14 Società Italiana di Nutrizione Umana, "Fabbisogno energetico medio (AR) nell'intervallo d'età 6-12 mesi" Società Italiana di Nutrizione Umana

15 Società Italiana di Nutrizione Umana, "Fabbisogno energetico medio (AR) nell'intervallo d'età 1-17 anni" Società Italiana di Nutrizione Umana

16 Romano C, "European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment" 65 : 242-264, 2017

17 European Medicines Agency, "European Medicines Agency recommends changes to the use of metoclopramide" European Medicines Agency

18 Tomomasa T, "Erythromycin induces migrating motor complex in human gastrointestinal tract" 31 : 157-161, 1986

19 Caron F, "Effects of amoxicillin-clavulanate combination on the motility of the small intestine in human beings" 35 : 1085-1088, 1991

20 Gomez R, "Effect of amoxicillin/clavulanate on gastrointestinal motility in children" 54 : 780-784, 2012

21 Fivez T, "Early versus late parenteral nutrition in critically ill children" 374 : 1111-1122, 2016

22 Mehta NM, "Defining pediatric malnutrition : a paradigm shift toward etiology-related definitions" 37 : 460-481, 2013

23 Becker P, "Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition : indicators recommended for the identification and documentation of pediatric malnutrition(undernutrition)" 30 : 147-161, 2015

24 Manini ML, "Application of pyridostigmine in pediatric gastrointestinal motility disorders : a case series" 20 : 173-180, 2018