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An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care.
BMC Pediatr 2014; 14:186BPed

Abstract

BACKGROUND

Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children.

METHODS

Data on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored.

RESULTS

Data were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p ≤ 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p ≤ 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p < 0.05) and a greater proportion of these delivered as EN (p < 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met.

CONCLUSIONS

Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other "non-nutritional" fluids whenever this is possible.

Authors+Show Affiliations

No affiliation info availablePaediatric Intensive Care Unit, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde, Glasgow G3 8SJ, UK. Emma@kehoes.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

25047460

Citation

Mara, Jackie, et al. "An Evaluation of Enteral Nutrition Practices and Nutritional Provision in Children During the Entire Length of Stay in Critical Care." BMC Pediatrics, vol. 14, 2014, p. 186.
Mara J, Gentles E, Alfheeaid HA, et al. An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care. BMC Pediatr. 2014;14:186.
Mara, J., Gentles, E., Alfheeaid, H. A., Diamantidi, K., Spenceley, N., Davidson, M., ... Gerasimidis, K. (2014). An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care. BMC Pediatrics, 14, p. 186. doi:10.1186/1471-2431-14-186.
Mara J, et al. An Evaluation of Enteral Nutrition Practices and Nutritional Provision in Children During the Entire Length of Stay in Critical Care. BMC Pediatr. 2014 Jul 21;14:186. PubMed PMID: 25047460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care. AU - Mara,Jackie, AU - Gentles,Emma, AU - Alfheeaid,Hani A, AU - Diamantidi,Krystalia, AU - Spenceley,Neil, AU - Davidson,Mark, AU - Young,David, AU - Gerasimidis,Konstantinos, Y1 - 2014/07/21/ PY - 2014/03/31/received PY - 2014/07/17/accepted PY - 2014/7/23/entrez PY - 2014/7/23/pubmed PY - 2015/4/18/medline SP - 186 EP - 186 JF - BMC pediatrics JO - BMC Pediatr VL - 14 N2 - BACKGROUND: Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children. METHODS: Data on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored. RESULTS: Data were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p ≤ 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p ≤ 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p < 0.05) and a greater proportion of these delivered as EN (p < 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met. CONCLUSIONS: Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other "non-nutritional" fluids whenever this is possible. SN - 1471-2431 UR - https://www.unboundmedicine.com/medline/citation/25047460/An_evaluation_of_enteral_nutrition_practices_and_nutritional_provision_in_children_during_the_entire_length_of_stay_in_critical_care_ L2 - https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-14-186 DB - PRIME DP - Unbound Medicine ER -