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Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit.
Nutr Clin Pract. 2017 Jun; 32(3):414-419.NC

Abstract

BACKGROUND

Early and optimal energy and protein delivery have been associated with improved clinical outcomes in the pediatric intensive care unit (PICU). Overweight and obese children in the PICU may be at risk for suboptimal macronutrient delivery; we aimed to describe macronutrient delivery in this cohort.

METHODS

We performed a retrospective study of PICU patients ages 2-21 years, with body mass index (BMI) ≥85th percentile and >48 hours stay. Nutrition variables were extracted regarding nutrition screening and assessment, energy and protein prescription, and delivery.

RESULTS

Data from 83 patient encounters for 52 eligible patients (52% male; median age 9.6 [5-15] years) were included. The study cohort had a longer median PICU length of stay (8 vs 5 days, P < .0001) and increased mortality rate (6/83 vs 182/5572, P = .045) than concurrent PICU patient encounters. Detailed nutrition assessment was documented for 60% (50/83) of patient encounters. Energy expenditure was estimated primarily by predictive equations. Stress factor >1.0 was applied in 44% (22/50). Median energy delivered as a percentage of estimated requirements by the Schofield equation was 34.6% on day 3. Median protein delivered as a percentage of recommended intake was 22.1% on day 3.

CONCLUSIONS

The study cohort had suboptimal nutrition assessments and macronutrient delivery during their PICU course. Mortality and duration of PICU stay were greater when compared with the general PICU population. Nutrition assessment, indirect calorimetry-guided energy prescriptions, and optimizing the delivery of energy and protein must be emphasized in this cohort. The impact of these practices on clinical outcomes must be investigated.

Authors+Show Affiliations

1 Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. 2 Harvard Medical School, Boston, Massachusetts, USA.3 Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.1 Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.4 University of São Paulo-Ribeirao Preto School of Medicine, São Paulo, Brazil.5 Universidad de Chile, Hospital Dr. Luis Calvo Mackenna, Providencia, Chile.1 Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. 2 Harvard Medical School, Boston, Massachusetts, USA. 3 Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28490231

Citation

Martinez, Enid E., et al. "Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 32, no. 3, 2017, pp. 414-419.
Martinez EE, Ariagno KA, Stenquist N, et al. Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit. Nutr Clin Pract. 2017;32(3):414-419.
Martinez, E. E., Ariagno, K. A., Stenquist, N., Anderson, D., Muñoz, E., & Mehta, N. M. (2017). Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 32(3), 414-419. https://doi.org/10.1177/0884533616670623
Martinez EE, et al. Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit. Nutr Clin Pract. 2017;32(3):414-419. PubMed PMID: 28490231.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit. AU - Martinez,Enid E, AU - Ariagno,Katelyn A, AU - Stenquist,Nicole, AU - Anderson,Daniela, AU - Muñoz,Eliana, AU - Mehta,Nilesh M, Y1 - 2016/10/06/ PY - 2017/5/12/pubmed PY - 2018/4/19/medline PY - 2017/5/12/entrez KW - critical care KW - energy KW - energy expenditure KW - intensive care unit KW - mortality KW - nutrition KW - nutrition assessment KW - obesity KW - pediatrics KW - protein SP - 414 EP - 419 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 32 IS - 3 N2 - BACKGROUND: Early and optimal energy and protein delivery have been associated with improved clinical outcomes in the pediatric intensive care unit (PICU). Overweight and obese children in the PICU may be at risk for suboptimal macronutrient delivery; we aimed to describe macronutrient delivery in this cohort. METHODS: We performed a retrospective study of PICU patients ages 2-21 years, with body mass index (BMI) ≥85th percentile and >48 hours stay. Nutrition variables were extracted regarding nutrition screening and assessment, energy and protein prescription, and delivery. RESULTS: Data from 83 patient encounters for 52 eligible patients (52% male; median age 9.6 [5-15] years) were included. The study cohort had a longer median PICU length of stay (8 vs 5 days, P < .0001) and increased mortality rate (6/83 vs 182/5572, P = .045) than concurrent PICU patient encounters. Detailed nutrition assessment was documented for 60% (50/83) of patient encounters. Energy expenditure was estimated primarily by predictive equations. Stress factor >1.0 was applied in 44% (22/50). Median energy delivered as a percentage of estimated requirements by the Schofield equation was 34.6% on day 3. Median protein delivered as a percentage of recommended intake was 22.1% on day 3. CONCLUSIONS: The study cohort had suboptimal nutrition assessments and macronutrient delivery during their PICU course. Mortality and duration of PICU stay were greater when compared with the general PICU population. Nutrition assessment, indirect calorimetry-guided energy prescriptions, and optimizing the delivery of energy and protein must be emphasized in this cohort. The impact of these practices on clinical outcomes must be investigated. SN - 1941-2452 UR - https://www.unboundmedicine.com/medline/citation/28490231/Energy_and_Protein_Delivery_in_Overweight_and_Obese_Children_in_the_Pediatric_Intensive_Care_Unit_ L2 - https://doi.org/10.1177/0884533616670623 DB - PRIME DP - Unbound Medicine ER -