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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 Jul; 102(1):199-206.AJ

Abstract

BACKGROUND

The impact of protein intake on outcomes in pediatric critical illness is unclear.

OBJECTIVE

We examined the association between protein intake and 60-d mortality in mechanically ventilated children.

DESIGN

In a prospective, multicenter, cohort study that included 59 pediatric intensive care units (PICUs) from 15 countries, we enrolled consecutive children (age: 1 mo to 18 y) who were mechanically ventilated for ≥48 h. We recorded the daily and cumulative mean adequacies of energy and protein delivery as a percentage of the prescribed daily goal during the PICU stay ≤10 d. We examined the association of the adequacy of protein delivery with 60-d mortality and determined variables that predicted protein intake adequacy.

RESULTS

We enrolled 1245 subjects (44% female) with a median age of 1.7 y (IQR: 0.4, 7.0 y). A total of 985 subjects received enteral nutrition, 354 (36%) of whom received enteral nutrition via the postpyloric route. Mean ± SD prescribed energy and protein goals were 69 ± 28 kcal/kg per day and 1.9 ± 0.7 g/kg per day, respectively. The mean delivery of enteral energy and protein was 36 ± 35% and 37 ± 38%, respectively, of the prescribed goal. The adequacy of enteral protein intake was significantly associated with 60-d mortality (P < 0.001) after adjustment for disease severity, site, PICU days, and energy intake. In relation to mean enteral protein intake <20%, intake ≥60% of the prescribed goal was associated with an OR of 0.14 (95% CI: 0.04, 0.52; P = 0.003) for 60-d mortality. Early initiation, postpyloric route, shorter interruptions, larger PICU size, and a dedicated dietitian in the PICU were associated with higher enteral protein delivery.

CONCLUSIONS

Delivery of >60% of the prescribed protein intake is associated with lower odds of mortality in mechanically ventilated children. Optimal prescription and modifiable practices at the bedside might enhance enteral protein delivery in the PICU with a potential for improved outcomes. This trial was registered at clinicaltrials.gov as NCT02354521.

Authors+Show Affiliations

Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; and nilesh.mehta@childrens.harvard.edu.Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; and.Department of Anesthesiology, Perioperative and Pain Medicine, and Harvard Medical School, Boston, MA; and Kingston General Hospital, Kingston, Canada.Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; and.Kingston General Hospital, Kingston, Canada.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25971721

Citation

Mehta, Nilesh M., et al. "Adequate Enteral Protein Intake Is Inversely Associated With 60-d Mortality in Critically Ill Children: a Multicenter, Prospective, Cohort Study." The American Journal of Clinical Nutrition, vol. 102, no. 1, 2015, pp. 199-206.
Mehta NM, Bechard LJ, Zurakowski D, et al. 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):199-206.
Mehta, N. M., Bechard, L. J., Zurakowski, D., Duggan, C. P., & Heyland, D. K. (2015). Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. The American Journal of Clinical Nutrition, 102(1), 199-206. https://doi.org/10.3945/ajcn.114.104893
Mehta NM, et al. 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):199-206. PubMed PMID: 25971721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. AU - Mehta,Nilesh M, AU - Bechard,Lori J, AU - Zurakowski,David, AU - Duggan,Christopher P, AU - Heyland,Daren K, Y1 - 2015/05/13/ PY - 2014/12/08/received PY - 2015/04/15/accepted PY - 2015/5/15/entrez PY - 2015/5/15/pubmed PY - 2015/9/12/medline KW - adequacy KW - children KW - energy KW - enteral nutrition KW - mortality KW - parenteral nutrition KW - protein SP - 199 EP - 206 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 102 IS - 1 N2 - BACKGROUND: The impact of protein intake on outcomes in pediatric critical illness is unclear. OBJECTIVE: We examined the association between protein intake and 60-d mortality in mechanically ventilated children. DESIGN: In a prospective, multicenter, cohort study that included 59 pediatric intensive care units (PICUs) from 15 countries, we enrolled consecutive children (age: 1 mo to 18 y) who were mechanically ventilated for ≥48 h. We recorded the daily and cumulative mean adequacies of energy and protein delivery as a percentage of the prescribed daily goal during the PICU stay ≤10 d. We examined the association of the adequacy of protein delivery with 60-d mortality and determined variables that predicted protein intake adequacy. RESULTS: We enrolled 1245 subjects (44% female) with a median age of 1.7 y (IQR: 0.4, 7.0 y). A total of 985 subjects received enteral nutrition, 354 (36%) of whom received enteral nutrition via the postpyloric route. Mean ± SD prescribed energy and protein goals were 69 ± 28 kcal/kg per day and 1.9 ± 0.7 g/kg per day, respectively. The mean delivery of enteral energy and protein was 36 ± 35% and 37 ± 38%, respectively, of the prescribed goal. The adequacy of enteral protein intake was significantly associated with 60-d mortality (P < 0.001) after adjustment for disease severity, site, PICU days, and energy intake. In relation to mean enteral protein intake <20%, intake ≥60% of the prescribed goal was associated with an OR of 0.14 (95% CI: 0.04, 0.52; P = 0.003) for 60-d mortality. Early initiation, postpyloric route, shorter interruptions, larger PICU size, and a dedicated dietitian in the PICU were associated with higher enteral protein delivery. CONCLUSIONS: Delivery of >60% of the prescribed protein intake is associated with lower odds of mortality in mechanically ventilated children. Optimal prescription and modifiable practices at the bedside might enhance enteral protein delivery in the PICU with a potential for improved outcomes. This trial was registered at clinicaltrials.gov as NCT02354521. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/25971721/Adequate_enteral_protein_intake_is_inversely_associated_with_60_d_mortality_in_critically_ill_children:_a_multicenter_prospective_cohort_study_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.114.104893 DB - PRIME DP - Unbound Medicine ER -