A randomized controlled trial of high parenteral protein feeding in septic children: the role of tumor necrosis factor-alpha-308 polymorphism

  • Gema Nazri Yanni Department of Pediatric, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik Hospital, Medan, Indonesia
  • Amir Sjarifuddin Madjid Department of Anesthesiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Aryono Hendarto Department of Pediatric, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Sri Widia Azraki Jusman Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0002-8169-6825
  • Zakiudin Munasir Department of Pediatric, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0002-7929-9011
  • Hindra Irawan Satari Department of Pediatric, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Iswari Setianingsih Eijkman Institute for Molecular Biology, Jakarta, Indonesia
  • Munar Lubis Department of Pediatric, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik Hospital, Medan, Indonesia
  • Sudigdo Sastroasmoro Department of Pediatric, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Keywords: children, high protein, outcome assessment, sepsis
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Abstract

BACKGROUND Septic children cause high protein degradation and inadequate nutritional intake would worsen the outcomes. In addition, there are conflicting results of association between tumor necrosis factor-α (TNFA)-308 polymorphism and poorer outcomes. This study was aimed to investigate the impact of high protein feeding in septic children and to examine the role of the TNFA-308 polymorphism in outcome of sepsis.

METHODS In this randomized controlled trial, septic children were randomly assigned to receive either high protein feeding (amino acid of 4 g/kg of body weight [kgBW]/day) or standard nutrient (amino acid of 2 g/kgBW/day) for three days in the pediatric intensive care unit of four hospitals in Indonesia. The patient’s enrollment was done between April 2016 and May 2017. The primary outcome was the pediatric logistic organ dysfunction (PELOD) score. TNFA-308 polymorphism was investigated using restriction fragment length polymorphism method in both groups. PELOD score was analyzed as mean differences and gene polymorphism was analyzed with mortality in a subgroup.

RESULTS There were 40 children in each group. PELOD score on day-1 (22.4 versus 20.5, p = 0.429), day-2 (20.5 versus 19.8, p = 0.815), and day-3 (18.8 versus 19.8, p = 0.772) were not lower in high protein feeding compared to standard feeding. TNFA-308 polymorphism had no role in mortality of both groups (high protein, p = 0.426; standard, p = 0.456).

CONCLUSIONS From this study, researchers concluded that a high protein intervention did not significantly decrease the PELOD score, length of stay, and duration of ventilator use in both groups.

References

  1. Wong HR, Nowak JE, Standage SW, Oliveira CF. Sepsis. In: Fuhrman BP, Zimmerman JJ, Carcillo JA, Clark RS, Rotta AT, Tobias JD, Relvas MS, et al, editors. Pediatric critical care. 4th ed. Philadelphia: Elsevier; 2011. p. 1413-29. https://doi.org/10.1016/B978-0-323-07307-3.10103-X

  2. Riley C, Wheeler DS. Prevention of sepsis in children: a new paradigm for public policy. Crit Care Res Pract. 2011;2012:437139. https://doi.org/10.1155/2012/437139

  3. Hadinegoro SR, Chairulfatah A, Latief A, Pudjiadi AH, Malisie RF, Alam A. National guidelines for the medical services of Indonesian pediatricians: diagnosis and management of sepsis in children. Jakarta: Indonesian Pediatrician Association. 2016. p. 1-7. Indonesian.

  4. Briassoulis G, Zavras N, Hatzis T. Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutrition. 2001;17(7-8):548-57. https://doi.org/10.1016/S0899-9007(01)00578-0

  5. Weijs PJ, Cynober L, DeLegge M, Kreymann G, Wernerman J, Wolfe RR. Proteins and amino acids are fundamental to optimal nutrition support in critically ill patients. Crit Care. 2014;18(6):591. https://doi.org/10.1186/s13054-014-0591-0

  6. Gerlach AT, Murphy C. An update on nutrition support in the critically ill. J Pharm Pract. 2011;24(1):70-7. https://doi.org/10.1177/0897190010388142

  7. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486-552. https://doi.org/10.1097/CCM.0000000000002255

  8. Kumar S, Rizvi M. Prognostic serum tumor necrosis factor-α in paediatric patients with sepsis. J Infect Dev Ctries. 2009;3(6):437-41. https://doi.org/10.3855/jidc.414

  9. Holmes CL, Russell JA, Walley KR. Genetic polymorphism in sepsis and septic shock, role in prognosis and potential for therapy. Chest. 2003;124(3):1103-15. https://doi.org/10.1378/chest.124.3.1103

  10. Mira JP, Cario A, Grall F, Delclaux C. Loosser MR, Heshmati F, et al. Association of TNF2, a TNF-α promoter polymorphism, with septic shock susceptibility and mortality: a multicenter study. JAMA. 1999;282(6):561-8. https://doi.org/10.1001/jama.282.6.561

  11. Nurnaningsih. Nutrition in critically ill children. In Pudjiadi AH, Latief A, Budiwardhana N, editors. Emergency Pediatric Textbooks. IDAI. 2013. p. 173-86. Indonesian.

  12. Honna L, Triratna S, Triwani, Theodorus. Use of pediatric logistic organ dysfunction (PELOD) in determining prognostic among pediatric intensive care unit patients. Pediatr Indones. 2010;50(6):347-50. https://doi.org/10.14238/pi50.6.2010.347-50

  13. Reid CL, Perrey C, Pravica V, Hutchinson IV, Campbell IT. Genetic variation in proinflammatory and anti-inflammatory cytokine production in multiple organ dysfunction syndrome. Crit Care Med. 2002;30(10):2216-21. https://doi.org/10.1097/00003246-200210000-00007

  14. Phumeetham S, Chat-Uthai N, Manavathongchai M, Viprakasit V. Genetic association study of tumor necrosis factor-alpha with sepsis and septic shock in Thai pediatric patients. J Pediatr (Rio J). 2012;88(5):417-22. https://doi.org/10.2223/JPED.2216

  15. Winiati E, Kosim MS, Supriatna M. Predicting PICU patient survival prognosis: pediatric logistic organ dysfunction vs pediatric index of mortality score. Pediatr Indones. 2012;52(3):165-9. https://doi.org/10.14238/pi52.3.2012.165-9

  16. te Braake FW, van den Akker CH, Wattimena DJ, Huijmans JG, van Goudoever JB. Amino acid administration to premature infants directly after birth. J Pediatr. 2005;147(4):457-61. https://doi.org/10.1016/j.jpeds.2005.05.038

  17. Reynolds RM, Bass KD, Thureen PJ. Achieving positive protein balance in the immediate postoperative period in neonates undergoing abdominal surgery. J Pediatr. 2008;152(1):63-7. https://doi.org/10.1016/j.jpeds.2007.05.042

  18. Geukers VG, Oudshoorn JH, Taminiau JA, van der Ent CK, Schilte P, Ruiter AF, et al. Short-term protein intake and stimulation of protein synthesis in stunted children with cystic fibrosis. Am J Clin Nutr. 2005;81(3):605-10. https://doi.org/10.1093/ajcn/81.3.605

  19. Cross-Bu JA, Hamilton-Reeves J, Patel JJ, Morris CR, Hurt RT. Protein requirements of the critically ill pediatric patient. Nutr Clin Pract. 2017;32 (1_suppl):128S-41S. https://doi.org/10.1177/0884533617693592

  20. Leteurtre S, Duhamel A, Grandbastien B, Proulx F, Cotting J, Gottesman R, et al. Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children. CMAJ. 2010;182(11):1181-7. https://doi.org/10.1503/cmaj.081715

  21. Azis AL. Nutritional support for severely ill children. Division of pediatric emergency department of Pediatrics FK Unair / Dr. Sutomo Hospital - Surabaya. p. 1-24. Indonesian.

  22. Van Waardenburg DA, de Betue CT, van Goudoever JB, Zimmerman LJ. Nutritional effects of early administration of a protein and energy enriched formula in critically ill infants; a randomized controlled trial [thesis]. Maastricht: Maastricht University. 2008. Chapter 6 and 7. p. 85-100.

  23. Dinata K, Runtunuwu AL, Mandei JM, Lolumbulan JH. Correlation between tumor necrosis factor-alpha and septic shock in children. Pediatr Indones. 2013;53(1):1-5. https://doi.org/10.14238/pi53.1.2013.1-5

  24. Botrán M, López-Herce J, Mencía S, Urbano J, Solana MJ, Garcia A. Enteral nutrition in the critically ill child: comparison of standard and protein-enriched diets. J Pediatr. 2011;159(1):27- 32.e1. https://doi.org/10.1016/j.jpeds.2011.02.001

Published
2020-03-26
How to Cite
1.
Yanni GN, Madjid AS, Hendarto A, Jusman SWA, Munasir Z, Satari HI, Setianingsih I, Lubis M, Sastroasmoro S. A randomized controlled trial of high parenteral protein feeding in septic children: the role of tumor necrosis factor-alpha-308 polymorphism. Med J Indones [Internet]. 2020Mar.26 [cited 2020Mar.30];29(1):19-5. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/2104
Section
Clinical Research