Award Title: A prospective observational study to explore the relationship between nuTRition, protein intake ANd muScle mass loss during and after Pediatric Intensive caRE: the TRANSPIRE study
Funder: Department of Health and Social Care

Abstract: Around 20 000 children are admitted to Paediatric Intensive Care Units (PICU) each year in the UK and Ireland and 13 000 of these stay > 3 days 1. The acuity of PICU patients is also increasing with some children stay for a prolonged period.   Despite this, the survival rate for paediatric critical illness is high at >96%1 but their recovery and physical morbidity can be prolonged, so interventions to improve their recovery are vital to improve both child and family outcomes.  Muscle wasting is dramatic in critically ill patients (both children and adults) and related to worsened outcomes 2-8. This muscle wasting delays the patient s rehabilitation and prolongs their recovery, due to reduced functional capacity associated with this loss in muscle mass 6. Therefore, we want to examine the relationships between muscle mass loss (measured via non-invasive ultrasound of the muscles) with nutritional intake and inflammatory markers during and after critical illness using standard, readily available bedside equipment.  We intend to undertake a prospective observational study to determine the association between muscle mass loss and function, nutrition and protein intake during and after pediatric critical illness over 24 months. We intend to recruit 50 children aged term to 16 years, who stay in PICU >48 hours from a single large mixed general and cardiac PICU (Alder Children s NHS Foundation Trust Liverpool, UK).  Our primary and secondary objectives are:  Primary:    To assess the relationship and determine any correlation between PICU-muscle wasting (assessed on ultrasound) and protein intake during critical illness (from admission to PICU discharge)   Secondary:    To assess the relationship and determine any correlation between PICU-muscle wasting and energy intake during critical illness (from admission to PICU discharge)  To assess the relationship and determine any correlation between PICU-muscle wasting and nitrogen balance during critical illness (from admission to PICU discharge)  To describe the relationship between PICU-muscle wasting and inflammatory markers (CRP) that relate to the severity of illness, over the PICU stay  To assess and further describe muscle wasting and function changes during PICU admission and from PICU discharge to 3 months after PICU discharge  To describe and further quantify risk factors for quantify PICU-muscle wasting   To examine and quantify PICU-muscle wasting and muscle function and its impact on short term (Length of ventilation, PICU length of stay, Hospital length of stay) and longer-term outcomes (Functional Status Score (FSS), muscle function recovery (Bayley s motor score, MFM 20 or MFM 32) and Quality of Life  (PedsQuAL) at 3 months after PICU discharge.      Study findings will be actively disseminated both nationally and internationally, at the annual UK PICU congress (PCCS), the national PICU Study Group (PICS-SG), at European meetings (ESPNIC) and via our study twitter account to both parents/carers and professionals. In addition, at least one paper will be submitted for publication in a high impact journal. From this exploratory study we anticipate that a combined nutrition and rehabilitation intervention may be able to be developed. This would be in collaboration with our colleagues undertaking the NIHR HTA-funded PERMIT Feasibility.

Lay Abstract: Around 20 000 children are admitted to the peadiatric intensive care unit (PICU) each year in the UK and Ireland and around 13 000 of these stay more than 3 days in intensive care, with some children staying a lot longer. As children s intensive care in the UK has improved in the last decade, almost all children now survive critical illness, but for many, their recovery is prolonged both physically and psychologically. Children on the breathing machine in intensive care lose a lot of weight and muscle very quickly, and this slows down their recovery and can lead to longer stays both in the intensive care and in hospital.  In adults in intensive care, research has shown that some of this muscle loss may be able to be lessened by given them a higher protein feed combined with early rehabilitation in intensive care, but in children we still do not know if this weight and muscle loss is modifiable by, and related to the nutrition and the amount of protein they receive This is what we want to find out, as children are not the same as adults, and frequently respond in different ways physiologically. Furthermore, children admitted to intensive care are quite different both in their age range and underlying conditions to those of adults.  To do this, we want to look at the children s muscles (by ultrasound, so using gel and running a probe over the muscle, which does not hurt at all) when they first come to intensive care, every few days, when they leave intensive care, when they leave the hospital and 3 months later. We will then see what happens to their muscles and how strong their muscles are, as well how much nutrition and protein they got in intensive care to see if they are related. We will also look at  one of the routinely collected daily blood tests during the time the child is in intensive care (called an inflammatory marker) as well as collect information about their age and weight, why they came to intensive care and other important things that might impact on their muscles. We will do this in one intensive care unit, Alder Hey Children s in Liverpool. This large PICU admits around 1200 children every year for lots of different reasons.  We have involved one of our past patients (and his faather), who is now 21 years old and who spent around 3 months in our intensive care a few years ago. He and his family say that this (weight loss and weak muscles) was a real problem for him and his recovery, and he believes it is a really important area to investigate.

Research Activity Codes: 2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS
Health Categories: GENERIC HEALTH RELEVANCE