For children who have experienced TBI, early nutritional support is associated with better outcomes and less mortality. “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 TBI, 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.
In their study (Lancet Neurol. 2013;12:546-553), the timing of nutritional support varied widely; 35.5% of the children received nutritional support 48 hours or less after the TBI, 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). “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. “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.”