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Challenges to nutrition therapy in the pediatric critically ill obese patient.
Nutr Clin Pract. 2015 Jun; 30(3):432-9.NC

Abstract

BACKGROUND

Obesity has been associated with poor clinical outcomes in critically ill children. The optimal approach to nutrition therapy in this vulnerable cohort is unclear.

METHODS

We report the nutrition management of 2 obese patients admitted to a pediatric intensive care unit (PICU). We focus on their nutrition assessment, energy requirements, and macronutrient delivery.

RESULTS

Case 1 describes a 19-year-old male, body mass index (BMI) 52.4 kg/m(2), who was admitted after emergent orthopedic surgery. Case 2 describes a 13-year-old male, BMI 31.5 kg/m(2), who was admitted with respiratory distress. Average PICU length of stay was 2 months. Nutrition assessments, including weight and height, were obtained early and regularly. Skinfold measurements were challenging. Estimated energy expenditure by predictive equations was significantly higher compared with measured resting energy expenditure (MREE) by indirect calorimetry in both cases. The Mifflin St-Jeor equation (in case 1) overestimated MREE by 681 kcal/d; the Schofield equation (in case 2) overestimated MREE by 662 kcal/d. Both patients had barriers to enteral nutrition and prolonged periods of time when they received no enteral nutrition, requiring parenteral nutrition for 28% and 75% of their PICU stay, respectively. Average daily protein delivered was 0.8 g/kg and 1 g/kg, below adult recommended protein intake for obese patients and pediatric recommendations for age.

CONCLUSIONS

These cases were notable for (1) challenges to anthropometric assessments, (2) inaccurate estimates of energy requirements, (3) suboptimal enteral nutrition delivery, (4) need for supplemental parenteral nutrition, and (5) suboptimal protein intake. Research is needed to determine the best approach to nutrition therapy in this cohort.

Authors+Show Affiliations

Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts enid.martinez@childrens.harvard.edu.Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts.Universidad Francisco Marroquin, Guatemala City, Guatemala.Universidad Francisco Marroquin, Guatemala City, Guatemala.Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25667233

Citation

Martinez, Enid E., et al. "Challenges to Nutrition Therapy in the Pediatric Critically Ill Obese Patient." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 30, no. 3, 2015, pp. 432-9.
Martinez EE, Ariagno K, Arriola A, et al. Challenges to nutrition therapy in the pediatric critically ill obese patient. Nutr Clin Pract. 2015;30(3):432-9.
Martinez, E. E., Ariagno, K., Arriola, A., Lara, K., & Mehta, N. M. (2015). Challenges to nutrition therapy in the pediatric critically ill obese patient. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 30(3), 432-9. https://doi.org/10.1177/0884533615569887
Martinez EE, et al. Challenges to Nutrition Therapy in the Pediatric Critically Ill Obese Patient. Nutr Clin Pract. 2015;30(3):432-9. PubMed PMID: 25667233.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Challenges to nutrition therapy in the pediatric critically ill obese patient. AU - Martinez,Enid E, AU - Ariagno,Katelyn, AU - Arriola,Aldis, AU - Lara,Kattina, AU - Mehta,Nilesh M, Y1 - 2015/02/09/ PY - 2015/2/11/entrez PY - 2015/2/11/pubmed PY - 2016/4/26/medline KW - calorimetry KW - critical care KW - intensive care KW - nutrition assessment KW - nutritional support KW - obesity KW - pediatrics SP - 432 EP - 9 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 30 IS - 3 N2 - BACKGROUND: Obesity has been associated with poor clinical outcomes in critically ill children. The optimal approach to nutrition therapy in this vulnerable cohort is unclear. METHODS: We report the nutrition management of 2 obese patients admitted to a pediatric intensive care unit (PICU). We focus on their nutrition assessment, energy requirements, and macronutrient delivery. RESULTS: Case 1 describes a 19-year-old male, body mass index (BMI) 52.4 kg/m(2), who was admitted after emergent orthopedic surgery. Case 2 describes a 13-year-old male, BMI 31.5 kg/m(2), who was admitted with respiratory distress. Average PICU length of stay was 2 months. Nutrition assessments, including weight and height, were obtained early and regularly. Skinfold measurements were challenging. Estimated energy expenditure by predictive equations was significantly higher compared with measured resting energy expenditure (MREE) by indirect calorimetry in both cases. The Mifflin St-Jeor equation (in case 1) overestimated MREE by 681 kcal/d; the Schofield equation (in case 2) overestimated MREE by 662 kcal/d. Both patients had barriers to enteral nutrition and prolonged periods of time when they received no enteral nutrition, requiring parenteral nutrition for 28% and 75% of their PICU stay, respectively. Average daily protein delivered was 0.8 g/kg and 1 g/kg, below adult recommended protein intake for obese patients and pediatric recommendations for age. CONCLUSIONS: These cases were notable for (1) challenges to anthropometric assessments, (2) inaccurate estimates of energy requirements, (3) suboptimal enteral nutrition delivery, (4) need for supplemental parenteral nutrition, and (5) suboptimal protein intake. Research is needed to determine the best approach to nutrition therapy in this cohort. SN - 1941-2452 UR - https://www.unboundmedicine.com/medline/citation/25667233/Challenges_to_nutrition_therapy_in_the_pediatric_critically_ill_obese_patient_ L2 - https://doi.org/10.1177/0884533615569887 DB - PRIME DP - Unbound Medicine ER -