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Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit.
Nutr Clin Pract. 2016 Oct; 31(5):673-80.NC

Abstract

BACKGROUND

Optimal nutrition therapy (NT) delivery is associated with improved outcomes in critically ill children. However, avoidable barriers impede delivery of optimal energy and protein in the pediatric intensive care unit (PICU). This study aims to describe the gap between energy and protein prescription and actual intake.

METHODS

Single-center prospective cohort study, including consecutive children (age: 1 month to 15 years) admitted to the PICU in southern Brazil. Demographics, clinical characteristics, and NT details were recorded.

RESULTS

We enrolled 130 patients: 37% female; median (interquartile range) age, 29.43 months (4.03, 100.63); PICU length of stay, 6 days (4, 13). Median predicted energy expenditure by Schofield equation and prescribed and actual energy intake were 47.13 kcal/kg/d (38.60, 55.38), 31.94 kcal/kg/d (13.99, 51.90), and 25.06 kcal/kg/d (10.21, 46.92), respectively. On average, actual energy intake was 47% of the predicted energy expenditure, and 68% of patients were underfed. Actual protein intake was 49% of the estimated requirement. NT was interrupted in 64% of patients.

CONCLUSIONS

There were significant gaps among the predicted requirement, prescription, and actual delivery of energy and protein in the PICU. Suboptimal prescription and multiple feeding interruptions resulted in underfeeding.

Authors+Show Affiliations

Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil yara.moreno@ufsc.br.Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil.Joana de Gusmão Children's Hospital, Florianópolis, Brazil.Joana de Gusmão Children's Hospital, Florianópolis, Brazil.Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27075179

Citation

Moreno, Yara M F., et al. "Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 31, no. 5, 2016, pp. 673-80.
Moreno YM, Hauschild DB, Barbosa E, et al. Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit. Nutr Clin Pract. 2016;31(5):673-80.
Moreno, Y. M., Hauschild, D. B., Barbosa, E., Bresolin, N. L., & Mehta, N. M. (2016). Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 31(5), 673-80. https://doi.org/10.1177/0884533616639125
Moreno YM, et al. Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit. Nutr Clin Pract. 2016;31(5):673-80. PubMed PMID: 27075179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Problems With Optimal Energy and Protein Delivery in the Pediatric Intensive Care Unit. AU - Moreno,Yara M F, AU - Hauschild,Daniela B, AU - Barbosa,Eliana, AU - Bresolin,Nilzete L, AU - Mehta,Nilesh M, Y1 - 2016/04/13/ PY - 2016/4/15/entrez PY - 2016/4/15/pubmed PY - 2017/2/10/medline KW - critical care KW - critical illness KW - energy KW - enteral nutrition KW - intensive care unit KW - parenteral nutrition KW - pediatrics KW - protein SP - 673 EP - 80 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 31 IS - 5 N2 - BACKGROUND: Optimal nutrition therapy (NT) delivery is associated with improved outcomes in critically ill children. However, avoidable barriers impede delivery of optimal energy and protein in the pediatric intensive care unit (PICU). This study aims to describe the gap between energy and protein prescription and actual intake. METHODS: Single-center prospective cohort study, including consecutive children (age: 1 month to 15 years) admitted to the PICU in southern Brazil. Demographics, clinical characteristics, and NT details were recorded. RESULTS: We enrolled 130 patients: 37% female; median (interquartile range) age, 29.43 months (4.03, 100.63); PICU length of stay, 6 days (4, 13). Median predicted energy expenditure by Schofield equation and prescribed and actual energy intake were 47.13 kcal/kg/d (38.60, 55.38), 31.94 kcal/kg/d (13.99, 51.90), and 25.06 kcal/kg/d (10.21, 46.92), respectively. On average, actual energy intake was 47% of the predicted energy expenditure, and 68% of patients were underfed. Actual protein intake was 49% of the estimated requirement. NT was interrupted in 64% of patients. CONCLUSIONS: There were significant gaps among the predicted requirement, prescription, and actual delivery of energy and protein in the PICU. Suboptimal prescription and multiple feeding interruptions resulted in underfeeding. SN - 1941-2452 UR - https://www.unboundmedicine.com/medline/citation/27075179/Problems_With_Optimal_Energy_and_Protein_Delivery_in_the_Pediatric_Intensive_Care_Unit_ L2 - https://doi.org/10.1177/0884533616639125 DB - PRIME DP - Unbound Medicine ER -