{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:25:18Z","timestamp":1788837918283,"version":"build-2803163510"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The role of timely nutritional support in the recovery of pediatric traumatic brain injury (PTBI) patients is crucial yet underexplored. The authors planned a retrospective study to investigate the timing of feeding initiation (early feeding [\u2264 48 hours] or delayed feeding [> 48 hours]), feeding pattern, and causes of feeding delay\/interruption in this cohort and studied the association of delayed feeding with outcomes in PTBI from a single center in a lower-middle-income country.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This retrospective, single-center study included PTBI patients \u2264 15 years of age admitted to the neurotrauma intensive care unit (NICU) within 24 hours of head injury over a period of 1 year. Demographic data, injury characteristics, and nutritional data were recorded from hospital electronic records. The outcome was measured in terms of NICU length of stay (LOS) and hospital LOS, infectious complications, neurological recovery at discharge, and mortality.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n One hundred PTBI patients were included, with mild (n = 28, 28%), moderate (n = 28, 28%), and severe (n = 44, 44%) traumatic brain injury (TBI). Patients had a median Glasgow Coma Scale (GCS) score of 9 (IQR 7, 13) at admission. Enteral nutrition was initiated early in 48% (n = 48) of patients. Only 39 of 100 patients reached 70% of their caloric target within 7 days. Causes of feeding interruption were planned surgical\/radiological and airway procedures (n = 89, 59.0%), feed intolerance (n = 25, 16.6%), feed refusal (n = 22, 14.6%), and hemodynamic instability (n = 15, 9.9%). Early initiation of enteral feeding was positively associated with reduced NICU LOS (r = 0.25) and overall hospital LOS (r = 0.33). Patients receiving early nutrition had a shorter hospital LOS (5.5 vs 10 days, p = 0.043) and higher GCS score at discharge (15 vs 13, p = 0.002). In mild TBI cases, early feeding significantly reduced NICU (2.5 vs 7.5 days, p = 0.01) and hospital (3.5 vs 13 days, p = 0.002) LOSs and improved discharge GCS score (15 vs 14.5, p = 0.02). These benefits were not observed in moderate or severe TBI patients. In multivariate analysis, undergoing neurosurgery influenced hospital LOS and discharge GCS score, and admission GCS score predicted mortality. The in-hospital mortality rate was 17%.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Early enteral feeding was initiated in 48% of PTBI patients. Common delays\/interruptions were due to planned procedures. Early enteral feeding was associated with shorter NICU and hospital LOSs. However, a definite association of early enteral feeding with improved neurological outcomes could not be established.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.6.peds24640","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:07:00Z","timestamp":1760148420000},"page":"747-754","source":"Crossref","is-referenced-by-count":3,"title":["Enteral feeding initiation and feeding practices in pediatric traumatic brain injury patients admitted to the neurotrauma intensive care unit"],"prefix":"10.3171","volume":"36","author":[{"given":"Ashish","family":"Bindra","sequence":"first","affiliation":[{"name":"Departments of Neuroanaesthesiology and Critical Care,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Salih","family":"Mohamed Samsudeen","sequence":"additional","affiliation":[{"name":"Departments of Neuroanaesthesiology and Critical Care,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richa","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Dietetics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Gupta","sequence":"additional","affiliation":[{"name":"Departments of Neuroanaesthesiology and Critical Care,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyaninder P.","family":"Singh","sequence":"additional","affiliation":[{"name":"Departments of Neuroanaesthesiology and Critical Care,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Phalak","sequence":"additional","affiliation":[{"name":"Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Gupta","sequence":"additional","affiliation":[{"name":"Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"497","article-title":"Epidemiology of global pediatric traumatic brain injury: qualitative review","volume":"91","author":"Dewan MC","year":"2016","unstructured":"Dewan MC, Mummareddy N, Wellons JC III, Bonfield CM. Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg. 2016;91:497\u2013509.e1."},{"issue":"11","key":"b2","series-title":"Lancet Neurol","first-page":"1004","article-title":"Traumatic brain injury: progress and challenges in prevention, clinical care, and research","volume":"21","author":"Maas AIR","year":"2022","unstructured":"Maas AIR, Menon DK, Manley GT, Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022;21(11):1004\u20131060."},{"issue":"6","key":"b3","series-title":"Childs Nerv Syst","first-page":"1119","article-title":"Traumatic brain injury in Indian children","volume":"34","author":"Chaitanya K","year":"2018","unstructured":"Chaitanya K, Addanki A, Karambelkar R, Ranjan R. Traumatic brain injury in Indian children. Childs Nerv Syst. 2018;34(6):1119\u20131123."},{"issue":"10","key":"b4","series-title":"Crit Care Med","first-page":"2258","article-title":"Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury","volume":"42","author":"Vavilala MS","year":"2014","unstructured":"Vavilala MS, Kernic MA, Wang J, Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Crit Care Med. 2014;42(10):2258\u20132266."},{"key":"b5","series-title":"Front Pediatr","first-page":"936150","article-title":"An exploratory assessment of the management of pediatric traumatic brain injury in three centers in Africa","volume":"10","author":"Raees M","year":"2022","unstructured":"Raees M, Hooli S, von Saint Andr\u00e9-von Arnim AO, An exploratory assessment of the management of pediatric traumatic brain injury in three centers in Africa. Front Pediatr. 2022;10:936150."},{"issue":"9","key":"b6","series-title":"Biomedicines","first-page":"2551","article-title":"Optimization of nutrition after brain injury: mechanistic and therapeutic considerations","volume":"11","author":"Poblete RA","year":"2023","unstructured":"Poblete RA, Yaceczko S, Aliakbar R, Optimization of nutrition after brain injury: mechanistic and therapeutic considerations. Biomedicines. 2023;11(9):2551."},{"issue":"1","key":"b7","series-title":"Am J Clin Nutr","first-page":"199","article-title":"Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study","volume":"102","author":"Mehta NM","year":"2015","unstructured":"Mehta NM, Bechard LJ, Zurakowski D, Duggan CP, Heyland DK. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. Am J Clin Nutr. 2015;102(1):199\u2013206."},{"issue":"1","key":"b8","series-title":"Pediatr Crit Care Med","first-page":"S68","article-title":"Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents\u2014second edition. Chapter 16. Glucose and nutrition","volume":"13","author":"Kochanek PM","year":"2012","unstructured":"Kochanek PM, Carney N, Adelson PD, Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents\u2014second edition. Chapter 16. Glucose and nutrition. Pediatr Crit Care Med. 2012;13(1):S68\u2013S71."},{"issue":"suppl","key":"b9","series-title":"J Neurosurg","first-page":"S14","article-title":"A new classification of head injury based on computerized tomography","volume":"75","author":"Marshall LF","year":"1991","unstructured":"Marshall LF, Marshall SB, Klauber MR, A new classification of head injury based on computerized tomography. 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JPEN J Parenter Enteral Nutr. 2015;39(2):211\u2013217."},{"issue":"1","key":"b15","series-title":"Neurocrit Care","first-page":"193","article-title":"Enteral nutrition initiation in children admitted to pediatric intensive care units after traumatic brain injury","volume":"30","author":"Balakrishnan B","year":"2019","unstructured":"Balakrishnan B, Flynn-O\u2019Brien KT, Simpson PM, Dasgupta M, Hanson SJ. Enteral nutrition initiation in children admitted to pediatric intensive care units after traumatic brain injury. 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Front Pediatr. 2022;10:905058."},{"key":"b18","article-title":"Guidelines for the Management of Severe Traumatic Brain Injury, 4th Edition","author":"Carney N","year":"2016","unstructured":"Carney N, Totten A, Ullman J, Guidelines for the Management of Severe Traumatic Brain Injury, 4th Edition. Brain Trauma Foundation; 2016. Accessed July 7, 2025. https:\/\/braintrauma.org\/coma\/guidelines\/severe-tbi"},{"issue":"1","key":"b19","series-title":"J Intensive Care","first-page":"8","article-title":"Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations","volume":"9","author":"Moonen HPFX","year":"2021","unstructured":"Moonen HPFX, Beckers KJH, van Zanten ARH. Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations. 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Neuropsychiatr Dis Treat. 2021;17:703\u2013710."},{"issue":"8","key":"b21","series-title":"JPEN J Parenter Enteral Nutr","first-page":"1475","article-title":"Randomized controlled trial of comparative hypocaloric vs full-energy enteral feeding during the first week of hospitalization in neurosurgical patients at the intensive care unit","volume":"44","author":"Mousavian SZ","year":"2020","unstructured":"Mousavian SZ, Pasdar Y, Ranjbar G, Randomized controlled trial of comparative hypocaloric vs full-energy enteral feeding during the first week of hospitalization in neurosurgical patients at the intensive care unit. 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World Neurosurg. 2016;91:497\u2013509.e1."},{"issue":"11","key":"b2","series-title":"Lancet Neurol","first-page":"1004","article-title":"Traumatic brain injury: progress and challenges in prevention, clinical care, and research","volume":"21","author":"Maas AIR","year":"2022","unstructured":"Maas AIR, Menon DK, Manley GT, Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022;21(11):1004\u20131060."},{"issue":"6","key":"b3","series-title":"Childs Nerv Syst","first-page":"1119","article-title":"Traumatic brain injury in Indian children","volume":"34","author":"Chaitanya K","year":"2018","unstructured":"Chaitanya K, Addanki A, Karambelkar R, Ranjan R. Traumatic brain injury in Indian children. Childs Nerv Syst. 2018;34(6):1119\u20131123."},{"issue":"10","key":"b4","series-title":"Crit Care Med","first-page":"2258","article-title":"Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury","volume":"42","author":"Vavilala MS","year":"2014","unstructured":"Vavilala MS, Kernic MA, Wang J, Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Crit Care Med. 2014;42(10):2258\u20132266."},{"key":"b5","series-title":"Front Pediatr","first-page":"936150","article-title":"An exploratory assessment of the management of pediatric traumatic brain injury in three centers in Africa","volume":"10","author":"Raees M","year":"2022","unstructured":"Raees M, Hooli S, von Saint Andr\u00e9-von Arnim AO, An exploratory assessment of the management of pediatric traumatic brain injury in three centers in Africa. Front Pediatr. 2022;10:936150."},{"issue":"9","key":"b6","series-title":"Biomedicines","first-page":"2551","article-title":"Optimization of nutrition after brain injury: mechanistic and therapeutic considerations","volume":"11","author":"Poblete RA","year":"2023","unstructured":"Poblete RA, Yaceczko S, Aliakbar R, Optimization of nutrition after brain injury: mechanistic and therapeutic considerations. Biomedicines. 2023;11(9):2551."},{"issue":"1","key":"b7","series-title":"Am J Clin Nutr","first-page":"199","article-title":"Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study","volume":"102","author":"Mehta NM","year":"2015","unstructured":"Mehta NM, Bechard LJ, Zurakowski D, Duggan CP, Heyland DK. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. Am J Clin Nutr. 2015;102(1):199\u2013206."},{"issue":"1","key":"b8","series-title":"Pediatr Crit Care Med","first-page":"S68","article-title":"Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents\u2014second edition. Chapter 16. Glucose and nutrition","volume":"13","author":"Kochanek PM","year":"2012","unstructured":"Kochanek PM, Carney N, Adelson PD, Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents\u2014second edition. Chapter 16. Glucose and nutrition. Pediatr Crit Care Med. 2012;13(1):S68\u2013S71."},{"issue":"suppl","key":"b9","series-title":"J Neurosurg","first-page":"S14","article-title":"A new classification of head injury based on computerized tomography","volume":"75","author":"Marshall LF","year":"1991","unstructured":"Marshall LF, Marshall SB, Klauber MR, A new classification of head injury based on computerized tomography. J Neurosurg. 1991;75(suppl):S14-S20."},{"key":"b10","series-title":"Front Neurol","first-page":"685","article-title":"Anatomical and physiological differences between children and adults relevant to traumatic brain injury and the implications for clinical assessment and care","volume":"8","author":"Figaji AA","year":"2017","unstructured":"Figaji AA. Anatomical and physiological differences between children and adults relevant to traumatic brain injury and the implications for clinical assessment and care. Front Neurol. 2017;8685."},{"issue":"1","key":"b11","series-title":"Crit Care","first-page":"173","article-title":"Optimizing enteral nutrition delivery by implementing volume-based feeding protocol for critically ill patients: an updated meta-analysis and systematic review","volume":"27","author":"Wang L","year":"2023","unstructured":"Wang L, Wang Y, Li HX, Optimizing enteral nutrition delivery by implementing volume-based feeding protocol for critically ill patients: an updated meta-analysis and systematic review. Crit Care. 2023;27(1):173."},{"issue":"3S suppl 1","key":"b12","series-title":"Pediatr Crit Care Med","first-page":"S1","article-title":"Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: update of the Brain Trauma Foundation Guidelines","volume":"20","author":"Kochanek PM","year":"2019","unstructured":"Kochanek PM, Tasker RC, Carney N, Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: update of the Brain Trauma Foundation Guidelines. Pediatr Crit Care Med. 2019;20(3S suppl 1):S1\u2013S82."},{"issue":"6","key":"b13","series-title":"J Neurosci Nurs","first-page":"291","article-title":"Effect of early nutritional support on intensive care unit length of stay and neurological status at discharge in children with severe traumatic brain injury","volume":"43","author":"Taha AA","year":"2011","unstructured":"Taha AA, Badr L, Westlake C, Dee V, Mudit M, Tiras KL. Effect of early nutritional support on intensive care unit length of stay and neurological status at discharge in children with severe traumatic brain injury. J Neurosci Nurs. 2011;43(6):291\u2013297."},{"issue":"2","key":"b14","series-title":"JPEN J Parenter Enteral Nutr","first-page":"211","article-title":"Epidemiology of interruptions to nutrition support in critically ill children in the pediatric intensive care unit","volume":"39","author":"Keehn A","year":"2015","unstructured":"Keehn A, O\u2019Brien C, Mazurak V, Epidemiology of interruptions to nutrition support in critically ill children in the pediatric intensive care unit. JPEN J Parenter Enteral Nutr. 2015;39(2):211\u2013217."},{"issue":"1","key":"b15","series-title":"Neurocrit Care","first-page":"193","article-title":"Enteral nutrition initiation in children admitted to pediatric intensive care units after traumatic brain injury","volume":"30","author":"Balakrishnan B","year":"2019","unstructured":"Balakrishnan B, Flynn-O\u2019Brien KT, Simpson PM, Dasgupta M, Hanson SJ. Enteral nutrition initiation in children admitted to pediatric intensive care units after traumatic brain injury. Neurocrit Care. 2019;30(1):193\u2013200."},{"issue":"1","key":"b16","series-title":"Otolaryngol Head Neck Surg","first-page":"87","article-title":"Randomized controlled trial assessing the feasibility of shortened fasts in intubated ICU patients undergoing tracheotomy","volume":"154","author":"Gonik N","year":"2016","unstructured":"Gonik N, Tassler A, Ow TJ, Randomized controlled trial assessing the feasibility of shortened fasts in intubated ICU patients undergoing tracheotomy. Otolaryngol Head Neck Surg. 2016;154(1):87\u201393."},{"key":"b17","series-title":"Front Pediatr","first-page":"905058","article-title":"Planned peri-extubation fasting in critically ill children: an international survey of practice","volume":"10","author":"Nabialek T","year":"2022","unstructured":"Nabialek T, Tume LN, Cercueil E, Planned peri-extubation fasting in critically ill children: an international survey of practice. Front Pediatr. 2022;10:905058."},{"key":"b18","article-title":"Guidelines for the Management of Severe Traumatic Brain Injury, 4th Edition","author":"Carney N","year":"2016","unstructured":"Carney N, Totten A, Ullman J, Guidelines for the Management of Severe Traumatic Brain Injury, 4th Edition. Brain Trauma Foundation; 2016. Accessed July 7, 2025. https:\/\/braintrauma.org\/coma\/guidelines\/severe-tbi"},{"issue":"1","key":"b19","series-title":"J Intensive Care","first-page":"8","article-title":"Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations","volume":"9","author":"Moonen HPFX","year":"2021","unstructured":"Moonen HPFX, Beckers KJH, van Zanten ARH. Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations. J Intensive Care. 2021;9(1):8."},{"key":"b20","series-title":"Neuropsychiatr Dis Treat","first-page":"703","article-title":"Low-protein, hypocaloric nutrition with glutamine versus full-feeding in the acute phase in ICU patients with severe traumatic brain injury","volume":"17","author":"Xiong W","year":"2021","unstructured":"Xiong W, Qian K. Low-protein, hypocaloric nutrition with glutamine versus full-feeding in the acute phase in ICU patients with severe traumatic brain injury. 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