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  • 1
    Online Resource
    Online Resource
    Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review
    AACN Publishing ; 2020
    In:  American Journal of Critical Care Vol. 29, No. 1 ( 2020-01-01), p. 33-45
    Details
    In: American Journal of Critical Care, AACN Publishing, Vol. 29, No. 1 ( 2020-01-01), p. 33-45
    Abstract: Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings. Objective To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improve nutrition delivery in critically ill children receiving mechanical ventilation. Methods Five hundred seventy-nine abstracts met the inclusion criteria and were screened by 2 reviewers according to prespecified criteria. Full-text reviews were performed on 28 articles; 11 studies were selected for detailed analysis. Because of the small number of eligible studies, broader searches were conducted. Results Only 5 studies with a collective enrollment of fewer than 200 children closely addressed the specific research question. These 5 studies did not report any similarity in feeding regimens, nor did they report nutritional outcomes. Two of the articles described findings from the same study population. Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis. Conclusions The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation.
    Type of Medium: Online Resource
    ISSN: 1062-3264 , 1937-710X
    URL: Article
    DOI: 10.4037/ajcc2020850
    Language: English
    Publisher: AACN Publishing
    Publication Date: 2020
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  • 2
    Online Resource
    Online Resource
    Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Contemporary Organ Dysfunction Criteria: Executive Summary
    American Academy of Pediatrics (AAP) ; 2022
    In:  Pediatrics Vol. 149, No. Supplement_1 ( 2022-01-01), p. S1-S12
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 149, No. Supplement_1 ( 2022-01-01), p. S1-S12
    Abstract: Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was composed of 88 members representing 47 institutions and 7 countries. We conducted systematic reviews of the literature to derive evidence-based criteria for single organ dysfunction for neurologic, cardiovascular, respiratory, gastrointestinal, acute liver, renal, hematologic, coagulation, endocrine, endothelial, and immune system dysfunction. We searched PubMed and Embase from January 1992 to January 2020. Study identification was accomplished using a combination of medical subject headings terms and keywords related to concepts of pediatric organ dysfunction. Electronic searches were performed by medical librarians. Studies were eligible for inclusion if the authors reported original data collected in critically ill children; evaluated performance characteristics of scoring tools or clinical assessments for organ dysfunction; and assessed a patient-centered, clinically meaningful outcome. Data were abstracted from each included study into an electronic data extraction form. Risk of bias was assessed using the Quality in Prognosis Studies tool. Consensus was achieved for a final set of 43 criteria for pediatric organ dysfunction through iterative voting and discussion. Although the PODIUM criteria for organ dysfunction were limited by available evidence and will require validation, they provide a contemporary foundation for researchers to identify and study single and multiple organ dysfunction in critically ill children.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2021-052888B
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2022
    detail.hit.zdb_id: 1477004-0
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  • 3
    Online Resource
    Online Resource
    A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness*
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Pediatric Critical Care Medicine Vol. 19, No. 3 ( 2018-03), p. e164-e171
    Details
    In: Pediatric Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 19, No. 3 ( 2018-03), p. e164-e171
    Abstract: To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness. Data Sources: For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017. Study Selection: Included were studies with subjects 3–18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension. Excluded were studies featuring patients with a history of cardiac arrest, traumatic brain injury, or genetic anomalies associated with neurocognitive impairment. Data Extraction: Twelve studies met the sampling criteria and were rated using the Newcastle-Ottawa Quality Assessment Scale. Data Synthesis: Ten studies reported significantly lower scores in at least one cognitive domain as compared to healthy controls or normed population data; seven of these—four case-control and three prospective cohort studies—reported significant lower scores in more than one cognitive domain. Risk factors associated with post critical illness cognitive impairment included younger age at critical illness and/or older age at follow-up, low socioeconomic status, high oxygen requirements, and use of mechanical ventilation, sedation, and pain medications. Conclusions: Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.
    Type of Medium: Online Resource
    ISSN: 1529-7535
    URL: Article
    DOI: 10.1097/PCC.0000000000001430
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2070997-3
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  • 4
    Online Resource
    Online Resource
    Anthropometry Based Growth and Body Composition in Infants with Complex Congenital Heart Disease
    SAGE Publications ; 2022
    In:  Clinical Nursing Research Vol. 31, No. 5 ( 2022-06), p. 931-940
    Details
    In: Clinical Nursing Research, SAGE Publications, Vol. 31, No. 5 ( 2022-06), p. 931-940
    Abstract: Infants with congenital heart disease (CHD) often have poor growth and altered body composition (fat and muscle accretion). Aim: Describe growth patterns in infants with CHD using interval weight, length, head circumference (HC), triceps (TSF), subscapular skinfolds (SSSF), and mid-upper arm circumference (MUAC) measurements. Subjects and Methods: A total of 120 infants enrolled: 48% healthy and 58% with CHD (45% single ventricle [SV]; 55% two ventricle [2V] physiology). Weight, length, HC, TSF, SSSF, and MUAC measured at 3-, 6-, 9-, and 12-months of age. Results: CHD infants had lower weight, length, and HC z-scores at 3-, 6-, and 9-months. At 9-months, infants with SV physiology had larger TSF and SSSF z-scores over 2V and healthy infants. Overall MUAC z-scores were smaller at 3- and 6-months in infants with CHD. Conclusison: Infants with CHD have a complex pattern of growth. Longitudinal growth and body composition measurements provide information to better understand this pattern.
    Type of Medium: Online Resource
    ISSN: 1054-7738 , 1552-3799
    URL: Article
    DOI: 10.1177/10547738221075720
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2034682-7
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  • 5
    Online Resource
    Online Resource
    Parental Decision-Making in the Pediatric Intensive Care Unit: An Integrative Review
    SAGE Publications ; 2021
    In:  Journal of Family Nursing Vol. 27, No. 2 ( 2021-05), p. 154-167
    Details
    In: Journal of Family Nursing, SAGE Publications, Vol. 27, No. 2 ( 2021-05), p. 154-167
    Abstract: Parents are commonly responsible for making health care decisions for their seriously ill children in the pediatric intensive care unit (PICU); however, the factors influencing their decisions may vary. This integrative review examined the empirical literature between 2013 and 2018 to understand factors pertaining to parents’ decision-making about serious illness care of their children in the PICU. Seventeen studies met the inclusion criteria with three key findings. First, parent–clinician communication in the PICU is critical; second, most parents want to be the final decision-maker for their critically ill child; and third, parents’ emotions, support systems, and the child’s clinical status impact decision-making. Parental perspectives are important to consider when discussing serious illness care decisions for critically ill children. Further inquiry is needed into how the parent–clinician encounter impacts the decision-making process and subsequent outcomes in this population.
    Type of Medium: Online Resource
    ISSN: 1074-8407 , 1552-549X
    URL: Article
    DOI: 10.1177/1074840720975869
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2070209-7
    SSG: 5,3
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  • 6
    Online Resource
    Online Resource
    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
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Pediatric Critical Care Medicine Vol. 18, No. 7 ( 2017-07), p. 675-715
    Details
    In: Pediatric Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 18, No. 7 ( 2017-07), p. 675-715
    Abstract: This document represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric ( 〉 1 mo and 〈 18 yr) critically ill patient expected to require a length of stay greater than 2 or 3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2,032 citations were scanned for relevance. The PubMed/Medline search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1,661 citations. In total, the search for clinical trials yielded 1,107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer one of the eight preidentified question groups for this guideline. We used the Grading of Recommendations, Assessment, Development and Evaluation criteria to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutritional assessment, particularly the detection of malnourished patients who are most vulnerable and therefore potentially may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery is an area of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.
    Type of Medium: Online Resource
    ISSN: 1529-7535
    URL: Article
    DOI: 10.1097/PCC.0000000000001134
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2070997-3
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  • 7
    Online Resource
    Online Resource
    Nasogastric Tube Placement and Verification in Children: Review of the Current Literature
    AACN Publishing ; 2014
    In:  Critical Care Nurse Vol. 34, No. 3 ( 2014-06-01), p. 67-78
    Details
    In: Critical Care Nurse, AACN Publishing, Vol. 34, No. 3 ( 2014-06-01), p. 67-78
    Abstract: Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. Although considered an innocuous procedure, placement of an NG-EAD carries risk of serious and potentially lethal complications. Despite acknowledgment that an abdominal radiograph is the gold standard, other methods of verifying placement location are widely used and have success rates from 80% to 85%. The long-standing challenges surrounding bedside placement of NG-EADs and a practice alert issued by the Child Health Patient Safety Organization on this issue were the stimuli for the conception of The New Opportunities for Verification of Enteral Tube Location Project sponsored by the American Society for Parenteral and Enteral Nutrition. Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all health care professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.
    Type of Medium: Online Resource
    ISSN: 0279-5442 , 1940-8250
    URL: Article
    DOI: 10.4037/ccn2014606
    Language: English
    Publisher: AACN Publishing
    Publication Date: 2014
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  • 8
    Online Resource
    Online Resource
    The prevalence and effects of aspiration among neonates at the time of discharge
    Cambridge University Press (CUP) ; 2017
    In:  Cardiology in the Young Vol. 27, No. 7 ( 2017-09), p. 1241-1247
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 27, No. 7 ( 2017-09), p. 1241-1247
    Abstract: Neonates undergoing heart surgery for CHD are at risk for postoperative gastrointestinal complications and aspiration events. There are limited data regarding the prevalence of aspiration after neonatal cardiothoracic surgery; thus, the effects of aspiration events on this patient population are not well understood. This retrospective chart review examined the prevalence and effects of aspiration among neonates who had undergone cardiac surgery at the time of their discharge. Introduction This study examined the prevalence of aspiration among neonates who had undergone cardiac surgery. Demographic data regarding these patients were analysed in order to determine risk factors for postoperative aspiration. Post-discharge feeding routes and therapeutic interventions were extracted to examine the time spent using alternate feeding routes because of aspiration risk or poor caloric intake. Modified barium swallow study results were used to evaluate the effectiveness of the test as a diagnostic tool. Materials and methods A retrospective study was undertaken of neonates who had undergone heart surgery from July, 2013 to January, 2014. Data describing patient demographics, feeding methods, and follow-up visits were recorded and compared using a χ 2 test for goodness of fit and a Kaplan–Meier graph. Results The patient population included 62 infants – 36 of whom were male, and 10 who were born with single-ventricle circulation. The median age at surgery was 6 days (interquartile range=4 to 10 days). Modified barium swallow study results showed that 46% of patients (n=29) aspirated or were at risk for aspiration, as indicated by laryngeal penetration. In addition, 48% (n=10) of subjects with a negative barium swallow or no swallow study demonstrated clinical aspiration events. Tube feedings were required by 66% (n=41) of the participants. The median time spent on tube feeds, whether in combination with oral feeds or exclusive use of a nasogastric or gastric tube, was 54 days; 44% (n=27) of patients received tube feedings for more than 120 days. Premature infants were significantly more likely to have aspiration events than infants delivered at full gestational age (OR p=0.002). Infants with single-ventricle circulation spent a longer time on tube feeds (median=95 days) than infants with two-ventricle defects (median=44 days); the type of cardiac defect was independent of prevalence of an aspiration event. Conclusions Aspiration is common following neonatal cardiac surgery. The modified barium swallow study is often used to identify aspiration events and to determine an infant’s risk for aspirating. This leads to a high proportion of infants who require tube feedings following neonatal cardiac surgery.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S104795111600278X
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2017
    detail.hit.zdb_id: 2060876-7
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  • 9
    Online Resource
    Online Resource
    Innovative Strategies for Feeding and Nutrition in Infants with Congenitally Malformed Hearts
    Cambridge University Press (CUP) ; 2009
    In:  Cardiology in the Young Vol. 19, No. S2 ( 2009-11), p. 90-95
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 19, No. S2 ( 2009-11), p. 90-95
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951109991673
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2009
    detail.hit.zdb_id: 2060876-7
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  • 10
    Online Resource
    Online Resource
    Oral feeding dysfunction in post-operative infants with CHDs: a scoping review
    Cambridge University Press (CUP) ; 2023
    In:  Cardiology in the Young Vol. 33, No. 4 ( 2023-04), p. 570-578
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 33, No. 4 ( 2023-04), p. 570-578
    Abstract: Post-operative oral feeding difficulties in neonates and infants with CHD is common. While pre-operative oral feeding may be normal, oral feeding challenges manifest in the post-operative period without a clearly defined aetiology. The objective of this scoping review was to examine post-operative oral feeding in full-term neonates and infants with a CHD. Electronic databases query (1 January 1975–31 May 2021), hand-search of the reference lists of included studies, contact with experts, and review of relevant conferences were performed to identify quantitative studies evaluating post-operative oral feeding in full-term neonates and infants with a CHD. Associations with additional quantitative variables in these studies were also examined. Twenty-five studies met inclusion criteria. Eighty per cent were cohort studies that utilised retrospective chart review from a single institution. The primary variable of interest in all studies was oral feeding status upon discharge from neonatal hospitalisation. The most common risk factors evaluated with poor feeding at time of discharge were birth weight (36% of included studies), gestational age (44%), duration of post-operative intubation (48%), cardiac diagnosis (40%), and presence of genetic syndrome or chromosomal anomaly (36%). The most common health-related outcomes evaluated were length of hospital stay (40%) and length of ICU stay (16%). Only the health-related outcomes of length of hospital stay and length of ICU stay were consistently significantly associated with poor post-operative oral feeding across studies in this review. A clear aetiology of poor post-operative oral feeding remains unknown.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951122001299
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2060876-7
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