Antioxidant micronutrients supplementation in ventilated critically ill children: An observational study

Introduction: In critically ill patients, antioxidant micronutrients may have an important role in the fight against oxidative stress. In adults, supplementations have been associated with reduction of mortality. In children, the actual needs and intakes are unknown and a systematic supplementation has not been yet recommended.

Objectives: The objective of this observational study was to assess antioxidant micronutrients intakes in children receiving or not supplementation.

Methods: Children with expected mechanical ventilation ≥72 hours were consecutively included. Antioxidant micronutrients intakes, i.e. vitamins C and E, copper, zinc and selenium, were recorded daily using a clinical information system. They were compared to the Dietary References Intakes for healthy children (DRI, 2001) in patients on enteral nutrition and to the guidelines of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition in children on parenteral nutrition. Energy balance was calculated as the difference between energy intake and energy expenditure measured by indirect calorimetry.

Results: We included 49 children, 25 boys and 24 girls, with a median age [IQR)] of 22 [4 – 40] months. 409 days were analyzed and 236 indirect calorimetry measurements performed. All children had enteral nutrition and 3 also had parenteral nutrition. 36 children were supplemented with vitamins and 9 with oligo-elements. Most children with supplementation had a mean intake for the studied period that reached the recommendations: 82% of children for vitamin C, 77% for vitamin E, 56% for zinc, 78% for copper and 89% for selenium. In contrast, only few children without supplementation reached the recommendations: 50% for vitamin C, 10% for vitamin E, 40% for zinc, 40% for copper and 5% for selenium. In children with supplementation, the intakes reached the recommendations the day after admission on average and still increased thereafter. In non-supplemented children, the recommendations were only reached after 4 – 11 days. Mean energy balance was -8 ± 16 kcal/kg/d in supplemented children (n = 40) and -20 ± 11 kcal/kg/d in non-supplemented children (n = 9), respectively (p= 0.042).

Conclusion: Supplementing critically ill children with vitamins and trace elements is necessary in order to reach at least the recommendations in antioxidant micronutrients for healthy children. On the other side, the consequences of excessive intakes are unknown.

Disclosure of Interest: None Declared