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Impact of Nutrition Support Team in Achieving Target Calories in Children Admitted in Pediatric Intensive Care Unit
Arsheen Zeeshan1, Qurat Ul Ain Nairn1, Muhammad Jawwad1
1the Departmnet of Pediatrics and Child Health, Aga Khan University, Karachi.
Insights
Nutrition support teams (NST) significantly improved early calorie and protein intake in mechanically ventilated children in the pediatric intensive care unit (PICU). This intervention led to better nutritional achievement and shorter PICU stays.
Area of Science:
- Pediatric Intensive Care
- Clinical Nutrition
- Mechanical Ventilation
Background:
- Achieving early target caloric goals is crucial for critically ill children.
- Mechanically ventilated children in the pediatric intensive care unit (PICU) often face nutritional challenges.
- Nutrition support teams (NST) play a vital role in optimizing patient nutrition.
Purpose of the Study:
- To evaluate the impact of an NST-led early enteral nutrition protocol (EENP) on achieving target caloric intake in mechanically ventilated children.
- To assess the effect of NST intervention on protein delivery and length of PICU stay.
Main Methods:
- Implementation of an EENP by the NST in a PICU setting.
- Comparison of outcomes between a pre-intervention group and a post-intervention group.
- Inclusion of children aged 1 month to 18 years requiring mechanical ventilation for >2 days.
- Definition of adequate energy intake as 70% of target on day 3; statistical analysis using Chi-square/t-test.
Main Results:
- The post-intervention group showed a significantly higher rate of achieving the 70% caloric target on day 3 (85.2% vs. 37.4%, P < 0.001).
- Adequate protein intake also improved significantly in the NST-supported group (76.5% vs. 37.4%, P < 0.001).
- The median PICU length of stay was reduced in the NST-supported group (4 days vs. 6 days, P < 0.001).
Conclusions:
- The introduction of an EENP managed by an NST effectively improves the achievement of early target caloric and protein intake in mechanically ventilated pediatric patients.
- NST intervention is associated with improved nutritional outcomes and a shorter PICU length of stay.
- Factors like age, illness severity, or organ support did not influence the achievement of caloric targets.
Objective:
To determine the impact of nutrition support team (NST) on achieving an early target caloric goal in mechanically ventilated children admitted in pediatric intensive care unit (PICU).
Methods:
An early enteral nutrition protocol (EENP) was implemented by NST to ensure early and adequate nutrition provision to PICU patients. All children (1 month- 18 years) that were admitted in PICU for >2days and received mechanical ventilation, with no contraindications to enteral feed, were included and data was compared with those of pre-intervention. The adequacy of energy intake was defined as 70% achievement of target energy intake on the third day of admission. Chi-square/t-test was used to determine the difference between different variables pre and post intervention.
Results:
Total 180 patients (99 and 81 in pre- and post-intervention group, respectively) were included. Overall, 115 (63.9%) received adequate calories (70%) on third day of admission. Of which 69 (85.2%) were from post intervention (P < 0.001; odds ratio [OR] 6.6, 95% confidence interval [CI] 3.195-13.73). Moreover, NST intervention also promoted adequate protein intake in 62 (76.5%) children compared to 37 (37.4%) in pre-intervention group (P < 0.001, OR 5.468, 95% CI 2.838- 10.534). The median (interquartile range) length of PiCU stay in pre-NST group was 6 (4-9) days and in NST supported group was 4 (3-4) days (OR 0.580, CI 0.473-0.712, P < 0.001). Age, severity of illness, multiorgan dysfunction syndrome, sepsis, need of organ support had no effect in achievement of caloric target in both the groups (P > 0.05).
Conclusion:
Introduction of EENP with NST helped in the achievement of better and quicker target caloric intake.
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