Background and Objective: There is no accepted nutrition approach for wound healing in children. Our aims were to determine optimal nutrition support for pediatric wound healing. Methods: We applied local methods to create evidence- and consensus-based recommendations, supported by implementation tools, including algorithms, clinical decision supports, and measures. We applied these recommendations to the care of 49 patients from December 5, 2011, to December 5, 2012. Results: Six articles were found that addressed our clinical questions, and we formulated 5 clinical recommendations. Evidence supported evaluating patients for vitamin C, zinc, and protein deficiency. Of the patients where laboratory values were checked, 9 patients were zinc deficient (33%) and 12 patients were vitamin C deficient (48%). Discussion and Practical Application: The implementation of our recommendations has led to increased identification of micronutrient deficiencies and closer monitoring of nutrition status and intake. Online clinical decision supports can accelerate the adoption of clinical recommendations and reduce provider practice variation.
BaharestaniMMRatliffCR. Pressure ulcers in neonates and children: an NPUAP white paper. Adv Skin Wound Care. 2007;20(4):208-220.
2.
SchindlerCAMikhailovTAKuhnEM. Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care. Am J Crit Care. 2011;20(1):26-34.
3.
CookRCBlinmanTA. Nutritional support of the pediatric trauma patient. Semin Pediatr Surg. 2010;19(4):242-251.
4.
BrownKLPhillipsTJ. Nutrition and wound healing. Clin Dermatol. 2010;28(4):432-439.
5.
ThompsonCFuhrmanMP. Nutrients and wound healing: still searching for the magic bullet. Nutr Clin Pract. 2005;20(3):331-347.
6.
FuhrmanMP. Wound healing and nutrition. Top Clin Nutr. 2003;18(2):100-110.
7.
DornerBPosthauerMEThomasD; National Pressure Ulcer Advisory Panel. The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Adv Skin Wound Care. 2009;22(5):212-221.
8.
Rodriguez-KeyMAlonziA. Nutrition, skin integrity, and pressure ulcer healing in chronically ill children: an overview. Ostomy Wound Manage. 2007;53(6):56-58.
9.
VegaA. A review of the efficacy of zinc, selenium, and vitamin C in the treatment of pressure ulcers. Top Clin Nutr. 2011;26(2):115-125.
10.
DesnevesKJTodorovicBECassarACroweTC. Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial. Clin Nutr. 2005;24(6):979-987.
11.
DalyJMLiebermanMDGoldfineJ. Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome. Surgery. 1992;112(1):56-67.
12.
ZampieriNZuinVBurroROttolenghiACamoglioFS. A prospective study in children: pre- and post-surgery use of vitamin E in surgical incisions. J Plast Reconstr Aesthetic Surg. 2010;63(9):1474-1478.
13.
WitteMBThorntonFJTantryUBarbulA. L-arginine supplementation enhances diabetic wound healing: involvement of the nitric oxide synthase and arginase pathways. Metabolism. 2002;51(10):1269-1273.
14.
WilmoreDW. The effect of glutamine supplementation in patients following elective surgery and accidental injury. J Nutr. 2001;131(9)(suppl):2543S-2549S.
15.
BergerMMBainesMChioleroRLWardleCACayeuxCShenkinA. Influence of early trace element and vitamin E supplements on antioxidant status after major trauma: a controlled trial. Nutr Res. 2001;21(1-2):41-54.
16.
LangerGKnerrAKussOBehrensJSchlomerGJ. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev. 2003;(4):CD003216.
17.
RojasAIPhillipsTJ. Patients with chronic leg ulcers show diminished levels of vitamins A and E, carotenes, and zinc. Dermatol Surg. 1999;25(8):601-604.
18.
EtteSIOfodileFAOluwasanmiJO. Vitamins and trace elements profiles in chronic leg ulcers in nigerians. Trop Geogr Med. 1982;34(1):73-75.
19.
WilkinsonAJEHawkeCC. Oral zinc for arterial and venous leg ulcers. Cochrane Database Syst Rev. 2000;(2):CD001273.
20.
ScholsJMHeymanHMeijerEP. Nutritional support in the treatment and prevention of pressure ulcers: an overview of studies with an arginine enriched oral nutritional supplement. J Tissue Viability. 2009;18(3):72-79.
21.
StrattonRJEkACEngferM. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev. 2005;4(3):422-450.
22.
HisashigeAOhuraT. Cost-effectiveness of nutritional intervention on healing of pressure ulcers. Clin Nutr. 2012;31(6):868-874.
23.
DornerB. Nutrition therapy and pressure ulcer prevention: new NPUAP-EPUAP guidelines, nutrition white paper cast new light on wound care. National Pressure Ulcer Advisory Panel. European Pressure Ulcer Advisory Panel. Long Term Living. 2009;58(8):18-20.
KleinmanRE; American Academy of Pediatrics; Committee on Nutrition. Pediatric Nutrition Handbook. Elk Grove Village, IL: American Academy of Pediatrics; 2009:1470.
26.
DugganCRizzoCCooperA. Effectiveness of a clinical practice guideline for parenteral nutrition: a 5-year follow-up study in a pediatric teaching hospital. JPEN: J Parenter Enteral Nutr. 2002;26(6):377-381.
27.
A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 2002;26(1)(suppl):1SA-138SA.
28.
MehtaNMCompherC; A.S.P.E.N. Board of Directors. A.S.P.E.N. clinical guidelines: nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr. 2009;33(3):260-276.
29.
ParkerMWSchaffzinJKLo VecchioA. Rapid adoption of Lactobacillus rhamnosus GG for acute gastroenteritis. Pediatrics. 2013;131(suppl 1):S96-S102.
