The effectiveness of high versus lower enteral protein intake, considering energy intake, on clinical outcomes in critically ill children: A systematic review and meta-analysis
Abstract
BACKGROUND & AIMS
The optimal protein intake for critically ill children remains uncertain. This systematic review aimed to evaluate the effectiveness of high versus lower enteral protein intake, accounting for energy intake, on clinical and nutritional outcomes in children hospitalized in pediatric intensive care units (PICU).
METHODS
Following the JBI methodology, a comprehensive search was conducted across Medline, CINAHL Ultimate, Embase, and Cochrane Library from inception to March 18, 2024. Randomized controlled trials (RCTs) involving critically ill children admitted to PICU for ≥48 h and receiving enteral nutrition were eligible. Studies comparing protein intake of 2 g/kg/day to internationally recommended intakes were included. Two independent reviewers screened, selected, extracted the data, and assessed the risk of bias using the JBI critical appraisal checklist for RCTs; a third reviewer resolved any disagreements. Meta-analyses were performed for nitrogen balance, PICU length of stay, prealbumin and blood urea levels using a random-effects model to account for between-study heterogeneity.
RESULTS
Eight RCTs were included, assessing high (n = 6) and low (n = 2) enteral protein intake versus the recommended intake, mostly in infants aged 2-4 months, with bronchiolitis or after cardiac surgery. Four studies presented an unclear risk of bias and four a high risk. High protein intake (∼3 g/kg/day) was associated with significantly higher nitrogen balance values…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 6 participants or records.
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