Temporal nutritional and inflammatory changes in children with severe head injury fed a regular or an immune-enhancing diet: A randomized, controlled trial

Objective. To analyze the effect of an immune enhancing (IE) diet on infection and metabolic indices in children with severe head injury fed either an IE or a regular formula. Design. Randomized, blinded, controlled study. Setting. Pediatric intensive care unit in a university hospital. Patients., A total of 40 mechanically ventilated children with severe head injury. Interventions. Within 12 hrs of pediatric intensive care unit admission, patients were randomized to receive a masked formula: either IE or regular formula. Feedings were advanced to a target volume of energy intake equal to 0.50%, 100%, 125%, 150%, and 150% of the predicted basal metabolic rate on days 1-5. Measurements and Main Results., Nutritional and metabolic indices; interleukins-1 beta, -6, and -8; tumor necrosis factor-CL; and outcome end points (survival, length of stay, length of mechanical ventilation) were compared between the two groups. Only interleukin-8 levels were lower in the IE group compared with the regular formula group by day 5 (23.6 +/- 1.5 vs. 35.5 +/- 4 pg/mL, p <.04). In multivariate regression analysis, interleukin-8 was also independently negatively correlated with immunonutrition (p <.04). Nitrogen balance became positive in 30.8% of patients in the regular formula group and in 69.2% of patients in the IE group by day 5 (p <.05). Less gastric cultures were positive in the IE group compared with the regular formula group (26.7% vs. 71.4%, p <.02). Nosocomial infections (15% vs. 25%), length of stay (16.7 vs. 12.2 days), length of mechanical ventilation (11 vs. 8 days), and survival (80% vs. 95%) did not differ between groups. Conclusions: Although immunonutrition might decrease interleukin-8 and gastric colonization in children with severe head injury, it might not be associated with additional advantage over the one demonstrated by regular early enteral nutrition.