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Nutritional support in 111 pediatric intensive care units: a European survey
Martijn van der Kuip1, Michiel J S Oosterveld, Marian A E van Bokhorst-de van der Schueren
1Department of Pediatrics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Insights
European pediatric intensive care units (PICUs) prioritize nutritional support with teams and software. However, energy needs for critically ill children are mostly estimated, not measured, highlighting a gap in precise nutritional management.
Area of Science:
- Pediatric intensive care
- Clinical nutrition
- Nutritional support strategies
Background:
- Nutritional management is crucial for critically ill children.
- Current practices in European pediatric intensive care units (PICUs) regarding nutritional support require investigation.
- Understanding energy requirement assessment is key to optimizing patient outcomes.
Purpose of the Study:
- To investigate contemporary nutritional management strategies in European PICUs.
- To specifically examine the methods used for determining energy requirements in pediatric intensive care patients.
- To identify the prevalence of nutritional teams, software, research, and training in this field.
Main Methods:
- A survey was conducted using a 35-item questionnaire distributed to 242 PICUs across 28 European countries.
- Data were collected from 111 PICUs (46% response rate) representing 24 countries.
- Information gathered included responsibility for nutritional support, team availability, energy assessment methods, nutritional status evaluation, and use of dedicated software.
Main Results:
- Physicians predominantly managed nutritional support, with 73% of PICUs having multidisciplinary nutritional teams.
- Energy requirements were mainly estimated using weight, age, and predictive equations; only 17% regularly measured energy expenditure via indirect calorimetry.
- Nutritional status was assessed through weight, physical examination, and biochemical parameters; 70% utilized specialized software for nutritional support.
Conclusions:
- European PICUs recognize the importance of nutritional support, evidenced by established teams, software use, research engagement, and training programs.
- Despite advancements, the assessment of energy requirements in pediatric intensive care patients relies heavily on estimations rather than direct measurements.
- There is a need to improve the measurement-based assessment of energy expenditure to enhance nutritional management in PICUs.
Objective:
To study current strategies in nutritional management of pediatric intensive care units (PICUs) in Europe, focusing on energy requirements.
Design And Setting:
Survey by a 35-item questionnaire sent to representatives of 242 PICUs in 28 countries. Addresses were obtained from national PICU associations and the members' list of the European Society of Pediatric and Neonatal Intensive Care.
Participants:
Staff members of 111 European PICUs (46%) from 24 countries.
Measurements And Results:
Predominantly physicians were reported to be responsible for nutritional support. In 73% of PICUs a multidisciplinary nutritional team was available. In most PICUs daily energy requirements were estimated using weight, age, predictive equations and correction factors. In 17% of PICUs energy expenditure was regularly measured by indirect calorimetry. Nutritional status was mostly assessed by weight, physical examination, and a wide range of biochemical blood parameters. Approximately 70% of PICUs used dedicated software for nutritional support. A similar percentage of PICUs regarded "nutrition" as a research topic and part of the residents' training program.
Conclusions:
Most European PICUs regard nutritional support as an important aspect of patient care, as shown by the presence of nutritional teams, software, research, and education. However, energy requirements of pediatric intensive care patient were based predominantly on estimations rather than on measurements.
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