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Nutrition support among critically ill children with AKI
Ursula G Kyle1, Ayse Akcan-Arikan, Renán A Orellana
1Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA. ukyle@bcm.edu
Clinical Journal of the American Society of Nephrology : CJASN
|January 8, 2013
Summary
Critically ill children often receive insufficient nutrition, especially those with acute kidney injury (AKI). Protein underfeeding is more pronounced than energy underfeeding in the first five days of pediatric intensive care unit (PICU) stay.
Area of Science:
- Pediatric critical care medicine
- Pediatric nephrology
- Clinical nutrition
Background:
- Critically ill children face high risks of underfeeding and acute kidney injury (AKI).
- Nutritional deficiencies can exacerbate health complications in pediatric intensive care unit (PICU) patients.
- This study investigates nutrition support adequacy in the initial 5 days of PICU admission.
Purpose of the Study:
- To determine the adequacy of nutrition support in critically ill children during the first 5 days of ICU stay.
- To compare nutrition delivery in patients with and without AKI.
- To identify patterns of energy and protein underfeeding.
Main Methods:
- Retrospective chart review of pediatric patients in the ICU for over 72 hours.
- Classification of patients based on modified pediatric RIFLE criteria for AKI.
- Analysis of nutrition intake, basal metabolic rate (BMR) estimation, and protein needs assessment.
Main Results:
- 61% of patients had no AKI, while 39% had some level of AKI (Risk, Injury, or Failure).
- Median 5-day energy intake was below estimated BMR; protein provision was significantly lower than energy provision (19% vs. 55%).
- Patients with Injury/Failure AKI were more likely to be fasted and receive less than 90% of estimated BMR compared to those without AKI or only in the Risk category.
Conclusions:
- Underfeeding is prevalent in critically ill children and is more severe in those with AKI.
- Protein underfeeding is more significant than energy underfeeding within the first 5 days of PICU admission.
- Optimizing nutrition support is crucial for ICU patients, particularly those with AKI.
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