Nutritional interventions and outcomes after severe traumatic brain injury in children: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Children suffering from severe traumatic brain injury (sTBI) often experience disrupted metabolism, leading to variations in energy expenditure, catabolism, and lipolysis that can negatively impact recovery. We aimed to describe the relationship between nutritional interventions and outcomes after severe traumatic brain injury (sTBI) in children.

METHODS

A systematic search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was conducted up to March 2025. Studies included children older than one month with sTBI and assessed nutritional interventions. Three reviewers screened titles and abstracts, and two performed full-text assessments and data extraction. Risk of bias was evaluated using the ROBINS-I tool. Primary outcome was neurologic or functional outcome. Secondary outcomes included mortality, length of stay, and nutrition-related measures. When possible, meta-analyses were performed using a random effects model.

RESULTS

From 3530 studies identified, 54 underwent full-text review and 5 retrospective cohort studies were included. Primary outcome was reported in three studies, with one reporting a significant association between timing of nutritional intervention and neurologic outcome and two not demonstrating an association. Delayed enteral nutrition (>48 h) was associated with a combined OR for mortality of 2.50 (0.87-7.20, I2 = 0 %). Unmet caloric intake yielded an OR for mortality of 0.94 (0.18-4.95, I2 = 0 %). Study risk of bias was significant.

CONCLUSIONS

Given the existing uncertainty and variability in practice, it is essential that nutrition strategies for children with sTBI be tailored to each patient's physiological needs. Continuous monitoring of the patient's nutritional status should be prioritized to ensure that interventions remain appropriate and effective throughout the course of treatment.