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Implementation of Nutrition Support Guidelines May Affect Energy and Protein Intake in the Pediatric Intensive Care
Insights
Implementing nutrition support (NS) guidelines in pediatric critical care units (PICUs) improved energy and protein intake in critically ill children. These guideline changes led to reduced nutritional deficits, enhancing patient care.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Evidence-based practice
Background:
- Critically ill children face significant risks of malnutrition, which is linked to increased morbidity and mortality.
- Undernutrition in pediatric intensive care units (PICUs) necessitates effective nutritional interventions.
Purpose of the Study:
- To assess the impact of implementing new nutrition support (NS) guidelines on energy and protein intake in a PICU.
- To evaluate changes in nutritional status before and after guideline implementation.
Main Methods:
- A retrospective study analyzing energy and protein intake for the first 8 days of PICU stay.
- Utilized Schofield equations for basal metabolic rate and American Society for Parenteral and Enteral Nutrition guidelines for protein needs.
- Statistical analysis included unpaired t tests, Pearson's chi-squared, and logistic regressions.
Main Results:
- Significant improvements in energy intake were observed in children aged 2 years and older from day 5 onwards post-guideline implementation.
- Protein intake improved in both younger and older age groups by day 5.
- Cumulative protein deficits per kilogram per day were significantly reduced in both age groups after guideline implementation.
Conclusions:
- Implementation of NS guidelines positively impacted energy and protein intake in critically ill children.
- The study suggests that NS guidelines are effective in improving nutritional support in the PICU setting.
Background:
Critically ill children are at risk of developing malnutrition, and undernutrition is a risk factor for morbidity and mortality.
Objective:
The study evaluated changes in the energy and protein intake before and after implementation of nutrition support (NS) guidelines for a pediatric critical care unit (PICU).
Design:
This retrospective study documented energy and protein intake for the first 8 days of PICU stay. Basal metabolic rate and protein needs were estimated by Schofield and American Society for Parenteral and Enteral Nutrition Guidelines, respectively.
Participants/Setting:
Three hundred thirty-five children from August to December 2012 (pre-implementation) and 185 from October to December 2013 (post-implementation).
Intervention:
Implementation of NS Guidelines.
Main Outcome Measures:
Changes in actual energy and protein intake in the post- compared with the pre-Implementation period.
Statistical Analysis Performed:
Unpaired t tests, Pearson's χ(2) (unadjusted analysis) were used. Logistic regressions were used to estimate odds ratios and 95% confidence intervals for protein and energy intake, adjusted for age, sex, and Pediatric Risk of Mortality score.
Results:
After the implementation of guidelines, significant improvements were seen during days 5 through 8 in energy intake among children 2 years of age and older, and in protein intake in both age groups (P<0.05). For the 8-day period, statistically or clinically significant improvements occurred in the cumulative protein deficit/kg/day, as follows: younger than 2-year-olds, -1.5±0.7 g/kg/day vs -1.3±0.8 g/kg/day, P=0.02; 2-year-olds or older, -1.0±0.6 g/kg/day vs -0.7±0.8 g/kg/day, P=0.01; and for the energy deficit/kg/d in 2-year-olds and older, -17.2±13.6 kcal/kg/day vs -13.3±18.1 kcal/kg/day, unpaired t test, P=0.07, in the pre- vs post-implementation period, respectively.
Conclusions:
The implementation of NS guidelines was associated with improvements in total energy in 2-year-olds and older and protein in younger than 2 and 2 years and older children by days 5 through 8, and protein deficits were significantly lower in the post- vs the pre-implementation period. The implementation of NS guidelines may have had a positive effect on improving NS in critically ill children.
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