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Feeding modality is a barrier to adequate protein provision in children receiving continuous renal replacement

Molly Wong Vega1, Marisa Juarez Calderon2, Naile Tufan Pekkucuksen2

  • 1Sections of Nephrology, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, Suite 245, Houston, TX, 77033, USA. mrvega@texaschildrens.org.

Pediatric Nephrology (Berlin, Germany)
|March 8, 2019
PubMed

Insights

Critically ill children on continuous renal replacement therapy (CRRT) often face malnutrition. Protein delivery is crucial, but transitioning from parenteral to enteral nutrition poses a significant nutritional risk, impacting goal achievement.

Area of Science:

  • Pediatric Critical Care
  • Nephrology
  • Clinical Nutrition

Background:

  • Critically ill children frequently experience malnutrition.
  • Acute kidney injury (AKI) in children is associated with significant protein deficits.
  • Adequate protein intake is linked to improved survival in pediatric critical care.

Purpose of the Study:

  • To assess nutritional intake and identify risks in critically ill children receiving CRRT.
  • To evaluate protein and energy delivery across different feeding modalities.
  • To determine the impact of feeding transitions on meeting nutritional goals.

Main Methods:

  • Prospective observational study of pediatric patients on CRRT >48 hours.
  • Exclusion of patients with inborn errors of metabolism.
  • Collection of data on energy, protein, and fluid intake, anthropometrics, and feeding modalities.

Main Results:

  • 41 pediatric patients received CRRT for a median of 17.3 days; 41% were malnourished at baseline.
  • Median protein delivery was 2 g/kg/day, with 51% receiving combined parenteral (PN) and enteral (EN) nutrition.
  • Patients receiving combined PN+EN met protein goals most frequently (65.3%), while those solely on EN met goals only 27.6% of the time.

Conclusions:

  • Enteral/oral nutrition alone is insufficient for critically ill children on CRRT to meet protein needs.
  • Transitioning from parenteral to enteral nutrition represents a critical period of nutritional risk.
  • Optimizing nutrition delivery, particularly during feeding transitions, is essential for this vulnerable population.
Abstract

Keywords:
AKICRRTEnteralNutritionParenteralPediatricsProtein

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