The following is a summary of “Gastrointestinal Biomarkers and Their Association with Feeding in the First Five Days of Pediatric Critical Illness,” published in the December 2023 issue of Pediatrics by Veldscholte, et al.

For a study, researchers sought to explore the longitudinal course of various gastrointestinal (GI) biomarkers and their potential association with enteral nutrition advancement (ENA) during pediatric intensive care unit (PICU) admission. Understanding these biomarkers could assist clinicians in predicting patients’ tolerance to enteral nutrition and optimizing individual nutritional intake.

This secondary analysis utilized Early versus Late Parenteral Nutrition data in the Pediatric Intensive Care Unit randomized controlled trial. Early initiation and gradual escalation of enteral nutrition (EN) were practiced. Plasma concentrations of cholecystokinin (CCK), leptin, glucagon, intestinal fatty acid-binding protein 2 (I-FABP2), and citrulline were measured at PICU admission, day 3, and day 5. ENA was defined as the percentage of predicted resting energy expenditure provided as kcal EN. Biomarker and ENA trends were analyzed for patients with samples at all time points using Friedman and Wilcoxon signed-rank tests. The association between ENA and biomarkers was assessed using a 2-part mixed-effects model, adjusting for potential confounders.

Of 172 patients (median age 8.6 years), 55 had samples at all time points. Median ENA increased from 0 (admission) to 14.5 (day 3) and 28.0 (day 5). During PICU stay, CCK and I-FABP2 concentrations significantly decreased, while glucagon concentrations increased significantly. Leptin and citrulline remained stable. However, none of the biomarkers demonstrated a longitudinal association with ENA.

Based on the current evidence, CCK, leptin, glucagon, I-FABP2, and citrulline do not provide additional value in predicting ENA during the first 5 days of pediatric critical illness.

Source: journals.lww.com/jpgn/fulltext/2023/12000/gastrointestinal_biomarkers_and_their_association.24.aspx